Unpacking the CMS Age-Friendly Hospital Measure
Beginning in 2025, hospitals participating in the Inpatient Quality Reporting (IQR) program are required to report on the CMS Age-Friendly Hospital Measure. This shifts the focus toward improving care for patients 65 and older through a structural approach. The aim is to reduce harm and enhance outcomes for older adults, who account for a large portion of hospital stays and costs.
The Five Attestation Domains for Hospitals
Hospitals must attest to their performance in five domains to meet the CMS age friendly requirement. Each domain contributes one point to a possible score of five. Attaining full compliance within each domain is necessary to earn the point, and these scores will be publicly displayed on the CMS Care Compare website.
1. Eliciting Patient Healthcare Goals
This domain focuses on understanding and honoring what older patients value in their care. This involves creating and using protocols for documenting patient goals and preferences, reviewing these before major changes in care, and engaging patients and families in decisions.
2. Responsible Medication Management
This addresses the specific medication needs of older adults to prevent issues from multiple medications or inappropriate drugs. Hospitals should establish regular medication reviews using guidelines, monitor records to avoid potentially inappropriate medications, and ensure clear communication about medication changes.
3. Frailty Screening and Intervention
This domain emphasizes proactive screening for common issues in older adults. Hospitals must use validated tools to screen for cognitive problems (like delirium), mobility issues, and malnutrition upon admission and when conditions change. Management plans should be implemented based on screening results.
4. Social Vulnerability
Recognizing that health involves more than just medical factors, this domain requires assessing and addressing social issues such as isolation, financial insecurity, and caregiver stress. Care plans should incorporate social determinants of health and include tailored interventions.
5. Age-Friendly Care Leadership
This domain focuses on integrating age-friendly principles throughout the hospital. Hospitals should appoint a leader or committee with authority to oversee initiatives and ensure continuous staff education on age-friendly practices.
The Relationship to the 4Ms Framework
The CMS Age-Friendly Hospital Measure is based on the 4Ms Framework, an evidence-based approach developed by the Institute for Healthcare Improvement (IHI) and The John A. Hartford Foundation. The 4Ms provide a simplified focus for the care of older adults.
What Matters
This aligns with the first CMS domain, emphasizing that care should be guided by the older adult's goals, preferences, and values.
Medication
Corresponding to the CMS medication domain, this principle promotes the use of age-friendly medications that don't negatively impact what matters, mentation, or mobility.
Mentation
This focuses on cognitive health, including preventing, identifying, and managing conditions like dementia and delirium. It relates to the frailty screening domain's focus on cognitive impairment.
Mobility
Promoting safe movement to maintain function and prevent falls, this principle is addressed in the frailty screening domain.
How the Measure Benefits Patients and Providers
Implementing the CMS Age-Friendly Hospital Measure is expected to improve healthcare quality. Older adults may experience better care tailored to their needs, reducing risks like falls and adverse drug events, potentially leading to improved outcomes and satisfaction.
Hospitals can also benefit from implementing age-friendly practices, which may result in shorter stays, fewer readmissions, and reduced costs. Structural improvements can make care delivery more efficient. Public reporting on Care Compare offers transparency and may attract patients. For more resources on this framework, visit the official Institute for Healthcare Improvement website.
Implementation Challenges and Solutions
Hospitals may face challenges like increased data requirements and the need for new systems, as well as staff training needs. Strategies to address these include comprehensive training for staff, allocating sufficient resources, using technology to improve data collection, and identifying areas for improvement through gap analysis.
Comparing Age-Friendly Standards
Here is a comparison of the Age-Friendly Health Systems (AFHS) initiative and the new CMS Age-Friendly Hospital Measure:
| Feature | Age-Friendly Health Systems Initiative | CMS Age-Friendly Hospital Measure |
|---|---|---|
| Scope | Broader movement across the care continuum (hospitals, clinics, long-term care). | Specific measure for hospitals in the Inpatient Quality Reporting program. |
| Basis | Built on the 4Ms Framework (What Matters, Medication, Mentation, Mobility). | Based on the 4Ms, but requires attestation across five specific domains. |
| Requirement | Voluntary participation, though widely adopted by thousands of sites. | Mandatory reporting for hospitals in the IQR program to avoid penalties. |
| Reporting | Not centrally reported to a government body. | Publicly reported on CMS Care Compare, including a 0-5 score. |
| Incentive | Improved quality of care, patient outcomes, and organizational reputation. | Avoidance of Medicare payment reductions; public recognition. |
The Future of Age-Friendly Care
The CMS age-friendly requirement is a significant step in senior healthcare, driving systemic change by requiring hospitals to focus on patient-centered, evidence-based practices for older adults. This reinforces the 4Ms framework and incentivizes hospitals to invest in geriatric care. For patients, it offers transparency and assurance of care tailored to their needs, potentially leading to better health outcomes and reduced harms.
