Mid Year UGS Review

It is the middle of the year and I find it useful to review our status and performance so far.
At the beginning of the year, we had a strategic meeting to lay out our goals and plans,
All our our goals and plans should stem from our mission. Our mission is the AGS' mission which is to improve the health, independence and quality of life of all older people. To me, a mission should be a concrete vision that one can see, feel hear and touch. It should be something that would engage us into action. To me, a more useful mission would be to identify problems in Geriatrics and find solutions to these problems and I would like to hear any opinions to the contrary that Geriatrics has a lot of problems.

So what were the goals that we talked about during the beginning of the year?
1. To promote Geriatrics and improve Geriatric expertise.
One of our plans was to hold after hours educational conferences. We were able to have just one. Pain Management in the Older Adult held at the Lamb Auditorium of St. Marks Hospital. Bryan Culliton and Holiday Retirement provided the food. Attendance was moderate, around 15 and so was the participation.

2. Increase membership and participation- how has our membership fared compared to previous years? We have 42 members right now. How would we measure our member's engagement? What can we do to improve membership and participation?

3.Increase revenue- What is our revenue right now and how does it compare to previous years? What can we do to improve revenue?
4 Reach out to Nursing Home Medical Directors- Michael Galindo and Health Insight are spearheading an effort to gather all nursing home medical directors in Salt Lake City to improve the quality of medical care in nursing homes.
5. To promote integration of care. This smacks of socialism. Yet this seems to be the way to go. Elderly Care is fragmented which contributes to inefficiencies and costs that are out of proportion to care. There is no coordination of care from one environment to another, from the nursing home to the hospital and vise versa, from the hospital to outpatient clinic. There is no integration in financial reimbursement. Fee for service rewards episodic care and there is no mechanism to reward for overall care of the individual patient, there is no reward for health promoting and preventive kinds of health care. I believe that Patient Centered Medical Homes and Accountable Care Organizations are the way to go and we should have a discussion, here in Salt Lake City about that.
6. In order for Geriatrics to survive, it needs to be able to differentiate itself from Primary Care. By its nature, Geriatrics is similar to Pediatrics in that it is Primary Care which means that it should provide comprehensive care to a particular age segment of the population with its own unique needs and situation. Yet just like Pediatrics, it needs to set itself apart from Primary Care. What I see right now is due to a lack of Geriatricians, by default, the role that Geriatricians are supposed to assume are being assumed by Primary Care Internal Medicine or Family Practice. The distinction between them is becoming more and more blurred. The Geriatrician is disappearing. Sometimes no one is even sure what a Geriatrician actually is. Its the classic problem of the chicken and the egg. There are not enough Geriatricians so the job that needs to be done cannot be done. Since the job cannot be done, then there is no job position( or the lack of ability to perform the job is compensated by something else) , so there is no demand for Geriaticians as reflected by a lack of proper financial reimbursement. And what does that lead to? Not enough Geriatricians. What the job description is, can be a topic for another discussion. This is just one of the problems that the AGS and UGS should be tackling. The recent appropriation of funding for the loan repayment program is just one small step towards solving this problem. Yet attracting more Geriatricians by providing incentives like loan repayment just addresses one end of the problem. One needs to address the other end, which is to establish demand.

7. To support the viability of Medicare - Medicare has been a godsend to our impoverished elderly and yet it has a lot of deficiencies and as a result is presently financially unsustainable. Steps are being taken with the Affordable Care Act to remedy this situation. Does it not seem like a no-brainer that a Geriatrician should be intimately involved in solving Medicare's problems ? Yet this does not seem to always be the case. I sometimes feel that the Geriatrician is relegated to the background.

Our performance should be measured against how we meet our goals. It is also of paramount importance that we have the right goals. These are some goals that I have found worthwhile. I would appreciate your input. I would like to hear from you what goals are important to you or if you feel that we are not gong in the right direction. Our success will rely on everyone's engagement and participation.