On April 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Medicare hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule.

Thanks to the American College of Surgeons and the Institute for Healthcare Improvement, who, along with the American College of Emergency Physicians (ACEP),  spearheaded the rule development, the new measure will encourage hospital systems to change the way they approach care for older patients. This will help evolve care standards to address the medical and social needs of older adults by incorporating ACEPs Geriatric Emergency Department Accreditation (GEDA) framework among other principles from the partner organizations.

“…we have concluded that this measure does support reliable practices that drive change, transparent reporting, and prioritization of resources to implement these best practices,” p. 910.

The proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2025. CMS is publishing this proposed rule to meet the legal requirements to update Medicare payment policies for IPPS hospitals and LTCHs on an annual basis.

 IPPS Proposed Rule by the Centers for Medicare & Medicaid Services

The Age-Friendly Hospital measure assesses hospital commitment to improving care for patients 65 years or older receiving services in the hospital, operating room, or emergency department (pg. 903).

This measure consists of 5 domains that address essential aspects of clinical care for older patients (full table on pg. 907):

1. Eliciting Patient Healthcare Goals
2. Responsible Medication Management
3. Frailty Screening and Intervention
4. Social Vulnerability
5. Age-Friendly Care Leadership

What does this mean?

The rule has several core components for champions of geriatric emergency care.

1. Mandates that hospitals attest that they either do or do not provide five core elements of Age-Friendly Care – and then publicly report these attestations.
2. Includes boarding reduction as a core component of delirium prevention
3. Requires hospitals to attest that they have an age-friendly champion tasked with ensuring compliance with all the components of the measure, meaning hospitals are going to identify clinical champions to drive this work forward.

This measure is an important, albeit initial, step in making mandatory improvements in hospital care for older adults.

What can you do to help?

This is a proposed measure, not to be set in place until Fall 2024. We need your voices to help show support for this important measure to increase the quality of care for older adults in the ED. To leave a comment to show your support, please submit your response by June 2, 2024. Leave your comment

More information:

CMS Transforming Episode Accountability Model Fact Sheet 

ACEP Age-Friendly Hospital Measure 

ACEP coverage on CMS measure