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I have a memory clinic in a rural area (Western North Carolina), I generally use the MOCA, however I have many patients who have education levels in the range of 2nd-6th grade. I have had to try and evaluate different cognitive domains based on just personal experience, using different parts of cognitive tests that I think a patient may be able to complete. Recently I gave the MOCA to my 8 year old and my 6 year old to try and see what areas they could perform on.  I spoke to the principal of the elementary school that my children attend, she has a PhD and interested in research. I was thinking about looking at each grade level, age level and seeing what they ...
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Last Friday, we hosted the Mount Sinai #Geriatrics and #GeriPal fellows in the AGS offices. It was fun and informative (at least I thought so, and I hope the fellows agree!).  One of the questions we fielded was about the upcoming launch of the American College of Surgeons (ACS) Geriatric Surgery Verification and Quality Improvement Program at their annual quality conference. Had we seen the article in the New York Times and what did we think about it? I quipped that I suspected we hadn’t been mentioned (we hadn’t) and then went on to talk about the AGS’s long-standing focus on improving the ability of surgical and related medical specialists to care for ...
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A number of AGS members have alerted us to changes in the terms of use for the Montreal Cognitive Assessment (MoCA), announced in an email from Dr. Ziad Nasreddine, the founder of MoCA Test Inc. Dr. Nasreddine holds the copyright to MoCA. AGS members are collaborating on an editorial for the Journal of the American Geriatrics Society ( JAGS ) that will lay out some of the implications of this change and potential strategies geriatrics could take in response. The AGS will be reviewing ways it can support members in identifying alternate instruments in the public domain, with the goal of ensuring members are aware of validated instruments that can support ...
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As many of you may have heard, a panel of federal appeals judges in New Orleans will soon weigh in on a lower court decision in Texas v. United States . This case from April 2018 saw Texas and 19 other states (plus two individual plaintiffs) argue successfully that the Affordable Care Act’s (ACA’s) individual mandate provision was unconstitutional after Congress eliminated it as part of tax reform passed in 2017. According to the Texas trial court, this action “compel[led] the conclusion” that the individual mandate ceased to be a Constitutional exercise of Congress’ taxing power because the associated financial penalty no longer “produce[d] at least some ...
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The Administration for Community Living (ACL) recently released the 2018 Profile of Older Americans , an annual summary of critical statistics related to the older population in the United States. Looking for a  CliffsNotes summary before your deeper dive (#SummerReading)? Check out this summary infographic compliments of the AGS. Want a PDF of the infographic? Click here. Loading... /
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Your bags are packed. Your Twitter Bingo card is prepped. Your #AGS19 app is downloaded. It’s time to start populating that meeting calendar.  I am hoping that, as you look at what you want to do, you’ll make it a priority to visit some of our AGS Health in Aging Foundation-supported trainee presenters. Thanks to support from AGS members, more than 50 trainees are presenting their work in Portland. We are #AGSProud of you for supporting the next generation of health professionals who are potentially interested in pursuing careers in aging research or already, in the case of our incoming fellows, embarked on these careers.  Click here  to see where ...
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We are delighted to report that the Health Resources and Services Administration (HRSA) has reversed its earlier decision that applicants holding Veterans Affairs (VA) appointments were ineligible for the Geriatrics Academic Career Award (GACA) program. This is an important change that aligns HRSA with other federal agencies (e.g., the National Institutes of Health, NIH) when determining eligibility for applicants who work in the VA.   When the AGS first learned about application issues for VA employees, we reached out to HRSA to ask that they reconsider this decision, citing NIH policy and noting that the initial decision risked penalizing geriatrics ...
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Don’t forget we can help enhance your proposal with opportunities to license AGS educational content, tools and programs.   GWEP funding is intended to support education and training for a host of health professions students, residents, fellows, faculty, and direct care workers at sites across the U.S. Access to our robust online portfolio of AGS content and resources can be adapted to meet your needs so you can hit the ground running with your successful GWEP application. You can choose to license the complete portfolio of AGS resources at GeriatricsCareOnline.org, or you can license specific AGS products —like the Geriatrics Review Syllabus , Geriatric ...
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Hi, all. Yesterday, the Centers for Medicare & Medicaid Services (CMS) released the final 2019 Medicare Physician Fee Schedule , which outlines all the payment policies, payment rates, and quality provisions for Medicare services to be provided in the next calendar year. The rule also include updates made to the Quality Payment Program (QPP) for Year 3.   There were several changes proposed for the Medicare Physician Fee Schedule next year that had the AGS concerned--principal among them revisions to reimbursement for evaluation and management (E/M) services (described in more detail below).  The AGS spent much of the summer and early fall compiling ...
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Last week (Sep. 28), the President signed into law the fiscal year (FY) 2019 Labor-Health and Human Services (HHS)-Education and Related Agencies spending bill. This is the first time in more than two decades that Congress passed the Labor-HHS-Education bill prior to the start of the next fiscal year, which began October 1. The bill, H.R. 6157, also includes the Department of Defense appropriations measure, and a continuing resolution to temporarily fund remaining government programs until all the appropriations bills can be signed into law. In order to avoid a partial government shutdown, Congress will have to pass the remaining appropriations bills before ...
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I want to start with a big thank you to the AGS members who have participated in our grass-tops and grassroots outreach to your members of Congress.  To date, there have been two letters sent to CMS from Capitol Hill and there is an additional letter in the works.  The sent letters can be found here (House Ways and Means Committee) and here (House Sign-On led by Representatives Brad Wenstrup (R-OH), Earl Blumenauer (D-OR), Marsha Blackburn (R-TN), and Doris Matsui (D-CA)). On Monday, AGS submitted two letters to the Centers for Medicare and Medicaid Services (CMS) that commented on the proposed rule.  The letters were the culmination of two-months of work ...
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Thanks to the many AGS members who have contacted Congressional representatives to convey concerns about the proposed change to the evaluation and management (E/M) payment codes in the Medicare Physician Fee Schedule Proposed Rule for 2019 (#MPFS2019).  Several AGS leaders who made these calls noted that Congressional staff are interested in gaining a better understanding of the proposal and the concerns we have. You may find it helpful to include these links in follow-up thank you notes (also a great best-practice recommendation) to Hill staff, who may end up using these resources to further educate your representatives:   The American Medical Association ...
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We now have a little over two weeks to the deadline (9/10) for comments on the #MPFS2019, so you can probably imagine the fever-pitched pace of our work as we round the bend on our final lap. Here are some highlights from the last week’s worth of action and activity:  What We’re Drafting/Doing In collaboration with our coalition, we’ve put two draft comment letters on the table for consideration. As our thinking currently stands, our first letter—intended for the Centers for Medicare & Medicaid (CMS) specifically—will detail our concerns around the evaluation and management (E/M) coding proposal and make recommendations for moving forward. Our ...
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Since my initial blog post about the proposed #MPFS2019 rule, AGS leaders, staff, and consultants have been working on our response to the proposed changes that CMS has put forward.  To date, we have largely maintained a focus on the E/M proposal because of the implications that that has for our members. In addition, our leaders, staff, and consultants have also reviewed the entire proposed rule to identify the proposals that could impact care of older Americans and we have engaged additional AGS leaders to help us with our comments. It really does take a village to analyze and then respond to a 1,400 page rule. On E/M, our work (which is described in more ...
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The Centers for Medicare and Medicaid Services (CMS) recently released the Medicare Physician Fee Schedule Proposed Rule for 2019 (#MPFS2019) . As a refresher: The #MPFS2019 outlines how the Centers for Medicare and Medicaid Services (CMS) intends to update Medicare payment policies for the year ahead. Every summer, reviewing and providing feedback to @CMSgov on #Medicare payment is a major focus for our AGS experts, regulatory consultants, and policy staff. This year, for the first time, @CMSgov combined the #MPFS2019 and what is normally a separate rule regarding plans to update the Quality Payment Program (#QPP). The result is a 1,400-page proposal which ...
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Hopefully everyone had safe trips back from #AGS18.  While we were away, the Trump Administration  unveiled a "recissions package," or a request for Congress to rescind certain spending items.  Many of the funds the Administration wants to cut are "unobligated," meaning they are leftover from programs that have not been reauthorized or no longer exist.    If Congress passes the rescissions package (which remains an uncertainty), it could make it more difficult to pass other kinds of spending legislation throughout the year. From HHS, the White House is proposing to rescind: $5.15 billion from the Children’s Insurance Fund (authority to obligate these ...
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Health Reform Update

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Hi, all. While you’re busy packing for #AGS18, here’s some great #geriatrics reading to keep you occupied: A summary of health reform action to-date from our consultants with Arnold & Porter in D.C. Happy reading! Nancy * * * What’s Happened When the 115 th Congress began, Republicans were very well-positioned to pass their ACA repeal/Medicaid reform package, as they controlled both chambers of Congress and the Administration. Their multiple attempts, however, got stuck in the Senate, which was unable to pass ACA repeal even under the budget reconciliation, which requires only a majority vote, as opposed to the standard three-fifths majority ...
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With all the excitement for the weekend and March Madness, hopefully you didn’t miss that we have some good news to report! Last week, Congressional leaders released (and President Trump signed) an Omnibus bill that will fund the federal government for the remainder of FY 2018. The bill includes $40.7 million for the Geriatrics Workforce Enhancement Program, an unprecedented $3 billion budget increase for NIH, $722 million for the Department of Veterans Affairs Medical and Prosthetic Research Program (along with report language championed by the AGS reinforcing the VA's growing need to prioritize research for our older veterans), and some important support for ...
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Earlier this year, I wrote about my experiences attending the Age and Disability: Beyond Stereotypes to Inclusion Workshop in AGS News . Sponsored by AARP and hosted by the Forum on Aging, Disability, and Independence, the workshop brought together panelists from a range of fields to discuss ways to disrupt stereotypes in everyday life, particularly when it comes to (you guessed it) age and disability. A summary of the workshop proceedings is now available for free at nationalacademies.org/BeyondStereotypes , and I think it’s a useful reminder of how important it is to expand our thinking beyond healthcare as we seek to disrupt and reframe aging.   In ...
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Last June, I had an opportunity to participate in the “Inclusion Across the Lifespan” workshop (Lifespan Workshop) that was held on the National Institutes of Health (NIH) campus in Bethesda, MD. For the past several years, I’ve been joining the AGS Research Committee delegation for its annual meeting with Drs. Hodes and Bernard and the many other NIA program staff that champion aging research across the NIH. Like those meetings, walking on the NIH campus reminded me of the important role that NIA has played in building the evidence base for geriatrics and improving how we care for older people.  I am delighted that the Lifespan Workshop led to a revision ...
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