Hard Work, Big Changes: American Geriatrics Society Efforts to Improve Payment for Geriatrics Care

Peter A. Hollmann, MD, AGSF; Robert A. Zorowitz, MD, MBA, AGSF; Nancy E. Lundebjerg, MPA; Alanna C. Goldstein, MPH; Alan E. Lazaroff, MD

Disclosures

J Am Geriatr Soc. 2018;66(11):2059-2064. 

In This Article

Abstract and Introduction

Abstract

This article examines the work and leadership of the American Geriatrics Society in making payment for services provided under new, innovative payment codes a reality for geriatrics healthcare professionals. We examine more than a decade of work spanning from a proposal to pay for comprehensive geriatric assessments in 2003 to the multiyear effort that led to Medicare coverage for transitional care management (2013), chronic care management (2015, 2017), and assessment and care planning for cognitive impairment (2017). We review the forces that created an environment for change and the concurrent work of the American Medical Association and the Centers for Medicare and Medicaid Services that made this possible. We highlight opportunities seized that led to seats on crucial panels and legislative victories that helped us make our case for improved payment for geriatrics care. Finally, we address lessons learned and address opportunities where we are currently active.

Introduction

The Medicare Physician Fee Schedule (MPFS) is how the Centers for Medicare and Medicaid Services (CMS) determines payment for clinician services. It is updated annually and reflects input from multiple stakeholders, including specialty societies, payers, and the public.

In the early 2000s, the MPFS did not contain codes that described the unique work of geriatrics health professionals who provide care to the oldest and frailest Americans. By 2017, that had changed. We believe that this is in large part due to the vision of the American Geriatrics Society (AGS) and our work over the past 15 years. This article tells the story of that work. For those with an interest in delving deeper into coding and reimbursement, we have developed a background primer on coding (Supplemental Appendix S1) and a glossary of key terms (Table 1).

Geriatrics health professionals are pioneers in advanced illness care for older persons, with a long-standing focus on championing interprofessional team care, eliciting personal care goals, and treating older people as whole persons rather than focusing on a single organ or disease. They typically care for the oldest and frailest Americans and, like general internal medicine and family medicine providers, provide primary care to this population. There is a current and growing shortage of geriatricians.[1] We have long known that one contributor to the shortage is that reimbursement for geriatrics health professionals, as with all of primary care, lags far behind reimbursement for procedural specialists. Our focus on reimbursement has been to ensure that the MPFS supports the type of expert primary care that all Americans will need as we age.

With the 2017 update of the MPFS, new codes were added that are critical to supporting longitudinal, goal-directed, coordinated team care for older adults with complex medical needs. The update included payment for existing Current Procedural Terminology (CPT) codes (prolonged services without direct patient contact and complex chronic care management) and payments for new codes (behavioral health integration services, psychiatric collaborative care management services and cognitive assessment, and care plan services). AGS played a lead role in creating two of these code sets. See Table 2 for a list of the codes that have been implemented since we began this work. We are appreciative of the leaders at CMS who met with us over the years and helped to advance our work. We also recognize that we would not have achieved this success without our partners, which include some dozen societies across a variety of specialties, including the American Medical Association (AMA).

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