Thoughts on the 2015 Annual AGS Meeting

I believe that conferences are only as useful as to the extent that you can put what you have learned into practice. This year's conference was shorter in terms of the number for days and yet there were a few aspects of the conference that made me feel I got my money's worth. The one thing that impressed me the most was the the Public Policy Lecture which was conducted by decision makers who work within Medicare, two of whom were Geriatricians. It fueled my hope that public policy is being shaped into a form that best addresses the problems we are currently facing with geriatric care. Through public advocacy, AGS was able to convince congress to repeal SGR and take steps to replace our current fee for service based system to a more cost effective value based care.

Just as I did last year, I attended this year's ADGAP meeting. This year's format was different in that the organizers chose practice challenges submitted by attendees. The challenge I submitted dealed with outpatient geriatric clinics. What I learned was that outpatient geriatric clinics, the way we are running it now is becoming more and more difficult to sustain. The challenge is how to maintain financial viability of a geriatric clinic, which due to increased complexity of the patients it sees, can only about 13 to 16 patients a day, as opposed to a regular primary care clinic which can see about 20 to 23 patients a day. And yet no one can deny the value of what we do in taking care of these patients with multiple complex problems where we can prevent unnecessary and expensive hospitalization and institutionalization. The case was presented before a panel of peers where suggestions were given. The recommendations were useful and yet do not seem to deal with the root cause of the problem. The problem which is that financial incentives are not aligned with the desired behavior which is appropriate care for patients with multiple chronic conditions.

Recently, AGS was able to convince Medicare to allow for a chronic care management code 99490. This is a step in the right direction, however this code only financially makes sense in large physician practices and the small reimbursement of 42 dollars does not justify the added paperwork and time just to submit the claim. This was discussed in the CPT coding session where I could sense Dr. Zorowitz’s frustration with the way Medicare has set up its CPT coding. Yet there is not much we can do about it. It is not for us to ask why it is only for us to do and die.

Just as in last year’s COSAR meeting, they invited speakers talking about significant issues in Geriatric Care. During this meeting, the invited Dr. Alan Lazaroff, a very interesting physician. He is the CPT adviser in the AMA Advisory Panel. He talked about the Chronic Care Management Code. He is one of the physician who understands the importance of aligning financial incentives with desired outcomes.

The conference was a showcase of different models of care, PACE, GRACE, Independence at Home Demonstration. It should be our task to study their usefulness and applicability and apply them to our own practices.

Butch Abueg
UGS President