As you well know, refocusing Medicare to efficiently manage chronic disease in addition to acute care is crucial to ensuring the delivery of quality health care to millions of elderly Americans. The American Geriatrics Society has vigorously supported legislative efforts to recognize the substantial complexities faced by physicians caring for chronically ill older adults over weeks, months, and years.

In a recent column, we discussed Geriatric Medicine: A Clinical Imperative for An Aging Population, a report released by the Association of Directors of Geriatric Academic Programs (ADGAP) and AGS that recommended, among other things, a shift in priorities to chronic care within Medicare. To that end, AGS joined the American College of Physicians, the American Academy of Family Physicians, the Alzheimer’s Association, and others in supporting the bipartisan Geriatric and Chronic Care Management Act (S. 2593). The bill takes up where the 2003 Geriatric Care Act (S. 387/H.R. 102) left off.

Introduced into Congress in late June, its aim is to help physicians who bill Medicare handle the human and material costs of caring for the 20% of beneficiaries whose health is impacted by five or more chronic conditions. While concurrent chronic illness in this 20% accounts for two-thirds of total Medicare spending, many health organizations, including AGS, believe that patients will receive better care if we can introduce a limited new chronic care benefit. The introduction of the bill, with support from grassroots, will hopefully change that.

Lawmakers have begun to take action to counter the deficiencies in Medicare’s fee-for-service policies, which don’t address the costs associated with two major services vital to managing overlapping conditions: geriatric assessments and care coordination services. Blanche Lincoln (D-AK) and Harry Reid (D-NV) were joined by nine other cosponsors, while Rep. Gene Green (D-TX) introduced a companion bill (H.R. 4689) in the House.

The bill spells out geriatric assessment as a concept, defining it as “an assessment of an eligible individual’s medical condition, functional and cognitive capacity, primary caregiver needs, and environmental and psychosocial needs.” Under the bill, providers would conduct this assessment for beneficiaries.

“We must realign the financial incentives within Medicare as part of a comprehensive system change,” it reads. “Medicare should be restructured to reimburse physicians and other qualified health professionals for the cost of coordinating care.”

Under the bill, physicians or health professionals who can bill directly under Medicare and who are in collaboration with a physician would have their care management services recognized financially. These services include:

1. Development of a care plan
2. Multi-disciplinary team conferences
3. Coordination with other providers
4. Medication management
5. Patient and family caregiver education
6. Self-management services
7. Telephone consultations, including 24-hour telephone availability
8. Management of transitions across settings, including end-of-life care planning
9. Referral to and coordination with community services

S. 2593 brings attention to deficiencies in the vendor-based chronic care improvement program (CCIP), which included the Medicare Prescription Drug, Improvement and Modernization Act, passed last year. AGS believes that this provision relies on a model that is ill suited to the challenges of managing chronic disease in older adults. The models on which they are based have been geared, traditionally, toward a younger patient base.

Moreover, according to AGS President Meghan Gerety, MD, “One of the central tenets of disease management—patient self education and management—fails to take into account the critical needs of patients with dementia, a key patient base in need of high-quality chronic care services.” Indeed, the bill’s language includes a mention of Alzheimer’s disease as a unique variable in treating older adults.

Visit www.americangeriatrics.org/news/gca_goto.shtml for more detailed information on the bill. AGS encourages its members to contact members of Congress at the grassroots level to build momentum for the bill. Information on how to effectively do so can be found at www.americangeriatrics.org/policy/ chroniccaremgmtact.shtml. Members can also visit www.myagsonline.org to view a legislative toolkit for tips on initiating and sustaining contacts with members of Congress. It is imperative that Medicare continue to evolve with the needs of the elder population while taking into account the livelihoods of those who earn their living from caring for them.

Linda Hiddemen Barondess
Executive Vice President