AGS Earns Seat on Influential Panel

Most of us who care for older adults were deeply disappointed this past February when, on the eve of the expiration of the latest Sustainable Growth Rate formula (SGR) “patch,” Congress again failed to take the opportunity to replace the flawed SGR with a viable alternative. Instead, lawmakers approved yet another patch, effective through January 1, 2013. Amid this disappointing news, however, there was some more encouraging news in February—that the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) had awarded the American Geriatrics Society (AGS) a permanent seat on that committee—a longstanding goal of the AGS.

This is good news for geriatrics and for our older patients because the RUC influences Medicare reimbursement rates. Comprised of an independent panel of physicians representing a wide range of medical specialties, the RUC makes recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding the value of the work and resources required to provide patient care. The RUC’s influence is significant. Before the AGS was awarded a permanent seat on the panel in February, it shared a rotating seat with other specialty organizations, occupying that seat part-time. In 2008, the AGS’ Meghan Gerety, MD, held the seat and was chosen to chair the RUC’s 5-year review committee, which determines the process the RUC uses to assess Medicare’s evaluation and management (E/M) codes. The process the RUC used that year ultimately led to the largest increases in payments for evaluation and management services since the Medicare fee schedule was created in 1992.

Among other things, AGS having been granted a permanent seat on the RUC is recognition of the essential role geriatrics plays in establishing standards of care for older adults, especially for those with complex, interacting, multiple chronic disorders (multimorbidity) who need the most involved, and often the most costly, care. As RUC Chair Barbara Levy, MD, noted after the society was granted the seat, “the experience [of AGS members on the committee] will be particularly important in our ongoing work to meet the unique health needs of an aging population and to improve care coordination for patients with chronic conditions.”

AGS’s permanent seat on the RUC will facilitate efforts to advance quality care for older patients with complex chronic problems. The RUC has long been an advocate of care coordination for elders and has encouraged CMS to recognize and provide appropriate compensation for those services necessary to ensure provision of comprehensive care, including patient education, medication management, and telephone consultations between healthcare providers and patients and their caregivers. Given the AGS’s expertise, the RUC will be better positioned to influence how CMS values geriatric services, such as coordinated care for older adults with multimorbidity.

In addition to working with other members of the RUC to ensure that quality geriatric care is properly valued, the AGS will continue to advocate for an appropriate alternative to the SGR. The Medicare Payment Advisory Commission (MedPAC) recently proposed a “fix” for the SGR that, among other things, would freeze most Medicare payments to primary care physicians for 10 years, and both cut specialists’ payments by 17% over 3 years and institute a freeze in payments for an additional 7 years. The AGS and other healthcare organizations, however, share concerns that MedPAC’s proposals will exacerbate shortages of geriatricians, other primary care physicians, and specialists caring for older adults. Instead of the MedPAC plan, the AGS supports a solution that blocks Medicare cuts mandated by the SGR and establishes a fairer system for updating physician payments, a system that would appropriately value primary care services, geriatrics expertise, and care coordination. The society has launched an advocacy campaign to replace the SGR with a much more viable solution. Please visit the society’s Foundation for Health in Aging Advocacy Center at https://bit.ly/HealthInAging and join this effort. It requires only a few minutes of your time.