Medicare Recognizes the Value of Preventive Care and Geriatric Assessment
Managing the care of older adults at risk for frailty and disability is very complex and time consuming. Preventive care for older adults is the first line of defense in recognizing the potential for developing chronic conditions that can further complicate care and lessen quality of life. In many cases, long-term effective management of these conditions across care settings begins because of thorough preventive care. Geriatric assessment can identify looming health problems early, enabling health care professionals to better devise plans of care and coordinate their delivery. Because preventive care is one of the hallmarks of geriatrics, the AGS has worked diligently for the inclusion of geriatric assessment coverage in Medicare. Health care professionals who provide these services are often the first to see those warning signs that point to the risk of substantial morbidity, such as patients at risk for development of type II diabetes.
Physicians and other health care professionals must weigh the overall burden on quality of life that complex health problems and their potential treatment will impose on patients and their caregivers, and act accordingly with other members of the health care team. Although the potential for early interventions to reduce morbidity and mortality in a disease such as breast cancer is commonly recognized, mitigating the impact of common chronic illnesses such as atherosclerotic heart disease, hypertension, depression, and osteoarthritis through prevention is still a fundamental, critical challenge for professionals committed to quality geriatric care. Fortunately, the Centers for Medicare and Medicaid Services (CMS) recently proposed regulations to the Medicare Modernization Act (MMA) of 2003 that would strengthen preventive care for older adults through functional screening and other measures, with the potential for further prolonging and enriching their lives.
You may have heard about the one-time “Welcome to Medicare” preventive examinations proposed for new enrollees and intended to diagnose problems earlier when treatment is likely to be more effective. The exams, if the regulations take effect, will be enhanced with education, counseling, and referral to other preventive services offered through the provider. Encouragingly, much of what the regulations call for can be described as components of a standard geriatric assessment—a review of the individual’s functional ability and level of safety, including essential factors such as hearing impairment, activities of daily living, falls risk, and home safety. Screening instruments selected at the discretion of the physician or other qualified provider, or any available standardized screening test recognized by the AGS and other medical organizations, would allow for billing of preventive services related to a host of functional and safety factors.
Along with well-accepted standard preventive services such as mammography and diabetes screening, the new regulations would require providers to conduct a review of the individual’s comprehensive medical and social history and potential risk factors for depression. We are hopeful that the final rule containing the benefit will maintain this important language. The AGS and its representatives in Washington, DC, have worked hard to ensure that the benefit will include meaningful evidence-based preventive components of geriatric assessment, long a critical attribute of high-quality geriatric care. The AGS will continue to be at the forefront of these and other necessary efforts to enhance the quality and success of geriatric care and to strengthen the practice of geriatric medicine.