What is the CMS Age Friendly Initiative?
The Centers for Medicare & Medicaid Services (CMS) age-friendly initiative is a quality measure designed to improve the health outcomes of older adult patients in hospital settings. Taking effect in 2025, this measure requires hospitals participating in the Inpatient Quality Reporting (IQR) Program to attest to their commitment to providing age-friendly care based on five key domains. The initiative is a response to a growing older adult population and aims to reduce harm, lower costs, and enhance the quality of care for patients aged 65 and over. Hospitals that do not report on this measure face Medicare payment reductions.
The framework is built upon the evidence-based 4Ms of age-friendly care: What Matters, Medication, Mentation, and Mobility. These four pillars provide a comprehensive, holistic approach to geriatric care, ensuring that treatment is aligned with patient goals and addresses the complex needs often faced by older adults.
The Five Domains of the CMS Age-Friendly Hospital Measure
The CMS initiative evaluates hospitals based on their performance across five distinct domains, requiring hospitals to attest that they have systems in place for each area. These domains include eliciting patient healthcare goals, responsible medication management, frailty screening and intervention, social vulnerability, and age-friendly care leadership.
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Eliciting Patient Healthcare Goals: Hospitals must have processes to document patient health goals and treatment preferences to support shared decision-making.
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Responsible Medication Management: This involves reviewing medications to optimize use and minimize potential harm in older adults.
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Frailty Screening and Intervention: Hospitals need to screen for and address frailty-related issues such as cognitive impairment, mobility problems, and malnutrition, and communicate these plans at discharge.
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Social Vulnerability: This domain requires hospitals to screen for social factors like isolation, economic insecurity, caregiver stress, and elder abuse, and provide necessary interventions or referrals.
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Age-Friendly Care Leadership: Hospitals must designate a leader or team to oversee and drive improvement in age-friendly care initiatives.
Comparison of the 4Ms Framework and CMS Age-Friendly Domains
The CMS measure's clinical basis is the 4Ms framework, developed by the Institute for Healthcare Improvement (IHI) and The John A. Hartford Foundation. The five domains of the CMS measure are the reporting structure for hospitals implementing the 4Ms.
| Feature | 4Ms Framework | CMS Age-Friendly Measure Domains |
|---|---|---|
| Purpose | A clinical framework for providing evidence-based, high-quality care to older adults. | A public reporting and payment incentive program for hospitals participating in the IQR program. |
| Core Pillars | What Matters: Patient goals and preferences Medication: Safe and effective medication use Mentation: Managing cognitive concerns Mobility: Promoting physical function. |
Eliciting Patient Healthcare Goals: Direct correlation with "What Matters" Responsible Medication Management: Direct correlation with "Medication" Frailty Screening and Intervention: Covers aspects of "Mentation" and "Mobility" Social Vulnerability: An additional screening requirement that links to "What Matters" and "Mentation" Age-Friendly Care Leadership: A structural, organizational component. |
| Action | A guide for clinical practice and care delivery. | A requirement for hospitals to attest they have systems in place to address the five domains. |
| Compliance | Voluntary participation in the Age-Friendly Health Systems movement for recognition. | Mandatory reporting under the IQR program to avoid payment penalties. |
Benefits of Participating in the Age-Friendly Initiative
Implementing the CMS age-friendly initiative offers advantages for both patients and healthcare organizations, including improved health outcomes, shorter hospital stays, reduced readmissions, and more patient-centered care for older adults. Hospitals can also benefit from financial incentives by avoiding Medicare payment reductions, enhancing their reputation through public reporting on Care Compare, improving operational efficiency, and driving continuous quality improvement.
Getting Started with the CMS Age-Friendly Measure
Hospitals can utilize resources from organizations like the Institute for Healthcare Improvement (IHI) to implement the 4Ms framework. Collaborative programs, such as the American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program, also align with the initiative's requirements and can aid in compliance.
Conclusion
The CMS age-friendly initiative is a crucial step towards prioritizing the specific needs of older adults in healthcare. By focusing on the five domains that align with the 4Ms framework, hospitals can improve patient outcomes and satisfaction. Understanding this measure is important for the future of geriatric care.
