Welcome Speech 2015 AGS Fall Meeting

Thank you all for attending our yearly UGS Meeting. This is the only time of the year when we as geriatricians have a chance to meet and discuss issues related to our work in caring for our geriatric patients.

The UGS was incorporated in 2009 and became an affiliate of the AGS in 2010 this would be our 6th year. Generally there are five stages as to an organizations life cycle
Stage one existence
Stage two survival
Stage three maturity
Stage four renewal
Stage five decline

we are presently still in the survival stage we look to pursue growth establish a framework and develop our capabilities we’re regularly setting targets for our organization but with the aim of generating enough revenue for survival and expansion we can either enjoy adequate growth to be able to enter the next stage or fail in achieving this and consequently fail to survive

The main driver for growth will be engagement to our mission. Our mission is UGS’s mission which is to improve the health independence and quality of life of all older people. To me a mission should be a concrete, tangible vision that one can almost feel and touch, something that you can sink your teeth into, a more useful mission would be to identify problems in geriatrics and find solutions to these problems
Donald Berwick, MD, who formerly headed CMS and the Institute for Health Care improvement first articulated the now often quoted Triple Aim
1. Improve the experience of care
2. Improve Population Health
3. Reduce the per capita cost of care

Most of Health Care Reform is now moving towards the achieving these goals.

The sustainable Growth Rate Formula has been repealed, but we need to support the viability of Medicare by providing appropriate Geriatric Care. The oldest segment of our population accounts for most of our Health Care Costs. In order to provide appropriate Geriatric Care, one of our goals has always been to correct the perceived lack of Providers and Geriatricians in particular. The recent appropriation of funds for the Loan Repayment Program of the Utah HealthCare Workforce Financial Assistance Program is one step in the right direction. But providing appropriate Geriatric Care means not just providing enough Geriatricians but in actually identifying and fulfilling unaddressed needs in Geriatric Care, just as in the case of the iPhone. Before the iPhone existed, we just did fine with our old dumb cellphones. Now, everyone seems to need smartphones.

So what are these unaddressed needs?
a.1. Integration of Care-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 health outcomes of the individual patient, there is no reward for health promoting and preventive kinds of health care

a.2.We have seen medical care become more focused on specialization, yet common sense dictates that specialized care does not fit care of the elderly with its multiple complexities and comorbidities. There is a need towards improving integrated coordinated patient centered care instead by promoting excellence in Geriatrics.
The University of Utah Division of Geriatrics has currently started working on PCMH. This is an important step in the creation of accountable care organizations. The utah partnership of value of health insight has recently held a forum on 3 utah health organizations that have become aco's

b. The AGS is presently paying attention to a lack of Geriatric Branding.
We need to define what is Geriatrics
what do geriatricians do
what does the public know about geriatrics
what should geriatricians focus on population health? health promotion?, chronic disease and syndromes?
how do we increase awareness among physician colleagues and what geriatricians do?
Are there other segments of the population we need to reach and support with geriatric care?

At the beginning of the year we had a strategic meeting to lay out our goals and plans
so what were the goals we talked about a at the beginning of the year
a.To promote geriatrics and improve geriatric expertise one of our plans was to hold after hours educational conferences we’re able to have just one, pain management in the older adult held at the auditorium of saint mark’s hospital

b.Increase membership- In 2015, we had 42 members, we will see how many members we will have this year. I urge you to invite anyone washo may be interested in joining UGS.

c.Increase Revenue- We currently have cash assets of 3263.30 $ as of 10/31/15 as compared to 2716.80 last year. Please review our handouts. Most of our revenue has come from membership fees. We welcome donations or any ideas on how to generate more revenue.

d. Reach out to more Geriatricians. 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.
the Special Forum, "Who is the 'House MD to Follow' at Nursing Facilities?" was held on August 31 at Snowbird Resort, immediately following the day's program at the Rocky Mountain Geriatrics Conference.
The forum was presided by Dr. Michael Galindo and was attended by individuals representing different disciplines in Nursing Home Care. Of note was the presence of Dr. Sarah Woolsey, the Medical Director for Health Insight a private, non-profit, community-based organization dedicated to improving health and health care.

e. And finally, Another goal, that is very important to me that we should have is to improve the status of Geriatricians. Dr. Joseph Ouslander once said that Geriatrics is like the Rodney Dangerfield of Medicine, “We don’t get no respect. “.Physicians are generally getting discouraged as they are feeling the loss of autonomy. We are seeing Medicine being more and more subservient to business. We have no control. This is being felt more in primary care. The problem is we have ceded control of how we take care of our patients to business. In order to be able to exert more control we should learn more about our economic environment. There should be a more equitable decision making relationship between business and medicine. One example is the HEDIS measures that are presently being used by insurance companies as pay for performance measures. Some of these measures are not appropriate for older patients. A more appropriate quality indicator is the ACOVE set of measures. (Assessing Care of Vulnerable Elders)

I believe that we in the UGS, can improve the status of Geriatricians by being the answer for these unmet needs and being properly recognized and rewarded for this.

We also have the American Geriatrics Society, which is attentive to our needs and is our link to policies that impact us on the Federal level. COSAR Co-Chairs Jim Powers and Kathy Frank drafted a set of COSAR goals where each state representative are invited to submit comments/prioritize items. Please let us know your needs and priorities by logging on to our website, www.utahags.org under the contact us page.

I have invited staff members from Health Insight and they will talk about the Utah Partnership for Value, We are hoping to collaborate with them in the future to provide value driven instead of fee for service Geriatric Care

Going forwards, I would like to introduce our new leaders, Dr. Michael Galindo, Vice president and president elect, and Kim Dansie, secretary treasurer.

In order to promote Geriatric Adovacy, we felt that we should acknowledge the achievements of a deserving individual as a model for all of us working in the field of Geriatrics. This year, we had 4 deserving candidates:

1. Becky Kapp, the Director of Aging and Adult Services for Salt Lake County
2. Senator Brian Shiozawa, who has been instrumental to the funding of the Rural Physician Loan Repayment Program
3. Anne Palmer, the Executive Director of the Utah Commission on Aging

The first recipient of the first Geriatric Advocate of the Year Award is someone who has my utmost respect, my mentor and someone who I would like to call my friend, Dr. Gerald Rothstein.

Florentino Abueg, MD
UGS President
November 18, 2015