Journal of Gerontological Nursing

AGS Update 

Leadership in the Clinic, Classroom, and on the Hill: AGS Making Public Policy Strides for 2019

Laurie G. Jacobs, MD, AGSF

Abstract

“We provide leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy.”

That, in a nutshell, is the mission of the AGS. And every day—in clinics, communities, classrooms, and labs across the country—our 5,000+ nurses, physicians, physician assistants, pharmacists, social workers, and many other interprofessional colleagues put that mission into practice. We work not only to impact how high-quality care takes shape but also to ensure it is implemented affordably, with a person-centered approach for all older individuals.

That work is critical, but it does not (and cannot) end in clinics, communities, classrooms, and labs. In a very real—if sometimes frustrating—way, the public policy arena precedes what takes shape in these spaces and places. Regulations and legislation set in motion priorities for our clinicians, community leaders, educators, and researchers (Hollmann, Zorowitz, Lundebjerg, Goldstein, & Lazaroff, 2018; Lundebjerg, Hollmann, Malone, & the AGS Board of Directors and Public Policy Committee, 2017; Lundebjerg, Jacobs, Trucil, Goldstein, & Saliba, 2018). That is why we place such a premium on our presence on Capitol Hill here at the AGS, and it is why we continue to dedicate time and attention to keeping you keyed in to our priorities—and yours!

Among the victories looming large at the end of 2018, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule. The Final Rule postponed an earlier proposal to “collapse” evaluation and management (E/M) coding for at least 2 years—a decision that has AGS and many others in the medical community breathing a sigh of relief (at least temporarily) (Lundebjerg et al., 2018).

In July 2018, CMS had outlined draft plans for a massive revision to reimbursement for E/M services, a revision that would have created a single-rate payment for almost all outpatient office visits irrespective of their length or complexity (Lundebjerg et al., 2018). By offering the same pay for all patients, such a change would have reduced access to care for older Americans—particularly those with multiple chronic conditions who require more time and attention from health professionals to receive the care they need (Lundebjerg et al., 2018).

In response, the AGS spent much of 2018 compiling feedback for CMS and launching a large-scale, multi-partner, and multi-pronged effort focused on addressing the consequences of the E/M proposal (Lundebjerg et al., 2018). This effort included an AGS-led multispecialty coalition that met with CMS leadership and submitted two joint letters to policymakers: one to CMS signed by 41 groups and a second to Congress signed by 40 organizations. Our core message across these letters rested on urging CMS to withdraw its proposal and work with stakeholders on a better solution (Lundebjerg et al., 2018). We are pleased that AGS, the multispecialty coalition, and other key stakeholders will now have that opportunity.

In other good news, CMS is finalizing E/M documentation reforms that will take effect in 2019, and the agency noted in its Final Rule that it has plans to reduce provider burden further through 2021. For 2019, changes for qualified health professionals include the following (CY 2019 MPFS Final Rule, 2018):

As this update went to press, the AGS was still reviewing the more than 2,200 pages of the Final Rule in detail, including the proposed delay of E/M changes to 2021, as well as other updates made to the MPFS and Quality Payment Program for 2019. As we work to share actionable next steps with members, more details about our response to the CMS E/M proposal can be found…

“We provide leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy.”

That, in a nutshell, is the mission of the AGS. And every day—in clinics, communities, classrooms, and labs across the country—our 5,000+ nurses, physicians, physician assistants, pharmacists, social workers, and many other interprofessional colleagues put that mission into practice. We work not only to impact how high-quality care takes shape but also to ensure it is implemented affordably, with a person-centered approach for all older individuals.

That work is critical, but it does not (and cannot) end in clinics, communities, classrooms, and labs. In a very real—if sometimes frustrating—way, the public policy arena precedes what takes shape in these spaces and places. Regulations and legislation set in motion priorities for our clinicians, community leaders, educators, and researchers (Hollmann, Zorowitz, Lundebjerg, Goldstein, & Lazaroff, 2018; Lundebjerg, Hollmann, Malone, & the AGS Board of Directors and Public Policy Committee, 2017; Lundebjerg, Jacobs, Trucil, Goldstein, & Saliba, 2018). That is why we place such a premium on our presence on Capitol Hill here at the AGS, and it is why we continue to dedicate time and attention to keeping you keyed in to our priorities—and yours!

CMS Delays Proposal to Restructure Physician Payment Until 2021

Among the victories looming large at the end of 2018, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule. The Final Rule postponed an earlier proposal to “collapse” evaluation and management (E/M) coding for at least 2 years—a decision that has AGS and many others in the medical community breathing a sigh of relief (at least temporarily) (Lundebjerg et al., 2018).

In July 2018, CMS had outlined draft plans for a massive revision to reimbursement for E/M services, a revision that would have created a single-rate payment for almost all outpatient office visits irrespective of their length or complexity (Lundebjerg et al., 2018). By offering the same pay for all patients, such a change would have reduced access to care for older Americans—particularly those with multiple chronic conditions who require more time and attention from health professionals to receive the care they need (Lundebjerg et al., 2018).

In response, the AGS spent much of 2018 compiling feedback for CMS and launching a large-scale, multi-partner, and multi-pronged effort focused on addressing the consequences of the E/M proposal (Lundebjerg et al., 2018). This effort included an AGS-led multispecialty coalition that met with CMS leadership and submitted two joint letters to policymakers: one to CMS signed by 41 groups and a second to Congress signed by 40 organizations. Our core message across these letters rested on urging CMS to withdraw its proposal and work with stakeholders on a better solution (Lundebjerg et al., 2018). We are pleased that AGS, the multispecialty coalition, and other key stakeholders will now have that opportunity.

In other good news, CMS is finalizing E/M documentation reforms that will take effect in 2019, and the agency noted in its Final Rule that it has plans to reduce provider burden further through 2021. For 2019, changes for qualified health professionals include the following (CY 2019 MPFS Final Rule, 2018):

  • Required documentation of an established patient's history will be limited to the interval history since the patient's previous visit.
  • The requirement to re-document information included by practice staff or the patient in the medical record will be eliminated.
  • The requirement to document justification for a home visit instead of an office visit will be eliminated.

As this update went to press, the AGS was still reviewing the more than 2,200 pages of the Final Rule in detail, including the proposed delay of E/M changes to 2021, as well as other updates made to the MPFS and Quality Payment Program for 2019. As we work to share actionable next steps with members, more details about our response to the CMS E/M proposal can be found in a recently published article in the Journal of the American Geriatrics Society, “Putting Complex Older Persons First: How the CMS 2019 Payment Proposal Fails Older Americans” (Lundebjerg et al., 2018).

Continuing to Support Training for the Geriatrics Workforce

The AGS also continues to advocate for federal programs and policies addressing the acute and growing nationwide shortage of geriatrics nurses, geriatricians, and all geriatrics health care professionals.

Most recently, the Health Resources & Services Administration (HRSA) announced two important funding opportunities—both critical to the future of the geriatrics workforce, and both representing hard work and advocacy on behalf of the AGS and our members. The new grants support the Geriatrics Workforce Enhancement Program (GWEP), the only federal program designed to increase the number of health professionals with the skills and training to care for older adults, and the Geriatrics Academic Career Award (GACA) program, a previously funded initiative that enabled career development for hundreds of clinician–educators before it was eliminated in 2015 (HRSA, 2018a,b).

Additional efforts—orchestrated in collaboration with the Eldercare Workforce Alliance (EWA) and the National Association for Geriatric Education (NAGE)—have focused on legislative proposals in the House and Senate to establish and authorize funding for the GWEP and reestablish and enhance GACAs.

The AGS, EWA, and NAGE have made significant progress toward that goal. In September 2017, Representatives Jan Schakowsky (D-IL), Doris Matsui (D-CA), and David McKinley (R-WV) introduced the Geriatrics Workforce and Caregiver Enhancement Act (H.R. 3713). A similar bill was introduced in the Senate in May 2018 by Senators Susan Collins (R-ME) and Bob Casey (D-PA), with a new update introduced in late January 2019. In addition, in July 2018, the House passed the Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) Act, which included geriatrics-specific language from H.R. 3713.

We are proud of the momentum we have helped kick start for geriatrics priorities on Capitol Hill, and we are prouder still of the support we have built among key members of Congress and their staff. We need your help to keep that momentum going! Consider adopting personal advocacy as one of your own New Year's resolutions for 2019. You can learn more about steps to put you (and geriatrics) on a course toward success by visiting cqrcengage.com/geriatrics. Support from constituents across the United States will be critical to ensuring law-makers recognize the importance of these legislative proposals, particularly the new Geriatrics Workforce Improvement Act introduced in the Senate earlier this year, so those New Year's resolutions couldn't be more timely!

Laurie G. Jacobs, MD, AGSF
President, American Geriatrics Society

References

Authors

The author has disclosed no potential conflicts of interest, financial or otherwise.

10.3928/00989134-20190211-06

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