AGS Commends Proposed Medicare Policies to Improve Care for Chronically Ill Older Adults

42 CFR Parts 405, 410, 411, 414, 417, 422, 423, 424, 425, and 460.

That may sound like a foreign language or binary code, but it is a combination of letters and numbers that quite literally represents the future for our nation’s largest insurer come 2017. It is the legislative moniker for the Code of Federal Regulations (CFR) encompassing the 2017 Medicare Physician Fee Schedule Proposed Rule. Released July 7 by the Centers for Medicare & Medicaid Services (CMS), the Physician Fee Schedule Proposed Rule reflects planned updates to payment policies, payment rates, and quality provisions for services furnished under Medicare for the year ahead. And, thanks to ongoing advocacy from the American Geriatrics Society (AGS) and from representative organizations from other medical specialties, those services and quality provisions are now poised to reflect our growing appreciation for several important facets of geriatric long-term care. 

In response to the release of the Physician Fee Schedule Proposed Rule, the AGS specifically commended CMS for continuing to support improved payment for services provided to Medicare beneficiaries with multiple chronic conditions. CMS proposed making payment for a number of services provided to chronically ill older adults—changes which, when finalized, will dramatically improve current payment for chronic care management and assessment as well as care planning for those with cognitive impairments. 

“We are delighted that CMS included these services in the 2017 Proposed Physician Fee Schedule. Their inclusion is a key component of better care,” said Nancy E Lundebjerg, MPA, chief executive officer of the AGS. “In proposing these codes, CMS is recognizing the importance of supporting health care professionals who provide high-quality, person-centered care to older adults with complex illness.”

Among many updates anticipated for 2017, one new proposal promises to make additional payments covering complex chronic care management; this comprises non-face-to-face care provided to the most severely ill Medicare beneficiaries. These are beneficiaries who suffer from two or more chronic illnesses and must have a care plan that is continually monitored and revised. The proposed payments will allow geriatricians and other health care professionals to develop the infrastructure and hire the clinical staff needed to provide high-quality, person-centered care while also helping seriously ill older adults avoid unnecessary or unwanted hospital visits. Importantly, CMS also proposed reducing the administrative burden of performing procedures for chronically ill patients, which will greatly increase their availability.

Additionally, the AGS recognizes significant progress in the form of a proposal to reimburse providers who assess and plan care for those with cognitive impairments. Individuals living with these conditions need to be diagnosed as early as possible to ensure that they receive high-quality care and are able to involve family members and caregivers in the care planning process. Continuing to build support for that precept into the framework of Medicare will do much to advance high-quality, person-centered care for particularly vulnerable older adults.

Other important CMS proposals for 2017 include recognition for the importance of collaborative care between primary care providers and psychiatrists when addressing psychiatric conditions like depression and anxiety, as well as when providing care to people with disorders that limit mobility. In both cases, CMS proposes extra payments that will allow providers to manage conditions more effectively.

In applauding CMS for these proposals, the AGS has been joined by a diverse cadre of stakeholders, including the American Academy of Home Care Medicine (AAHCM), the American Academy of Hospice and Palliative Medicine (AAHPM), the American Academy of Neurology (AAN), and AMDA—The Society for Post-Acute and Long-Term Care Medicine.

CMS will accept comments on the proposed rule through September 6, 2016, and will respond to these recommendations and remarks in a final rule released later this fall. The proposed rule is now available from the Federal Register at FederalRegister.gov/public-inspection, and representatives from the AGS are already at work digesting the full rule to share recommendations on behalf of the nearly 6000 geriatrics health care professionals that the Society represents.