What is the CMS Age Friendly Rule? An Overview
The CMS Age Friendly Rule is a mandatory reporting measure for hospitals in Medicare’s Inpatient Quality Reporting (IQR) Program, starting January 1, 2025. This measure assesses a hospital's capability and commitment to providing age-friendly care for patients aged 65 and older. It is a programmatic measure, focusing on whether hospitals have the necessary systems in place to provide evidence-based, goal-concordant care. Developed in collaboration with various organizations, the measure emphasizes structural improvements for older adults. Non-compliant hospitals may face financial penalties.
The 4Ms Framework: The Clinical Foundation
The CMS Age Friendly Hospital Measure is based on the Age-Friendly Health Systems' 4Ms Framework. The 4Ms framework is an evidence-based model designed to prevent harm and align care with patient preferences:
- What Matters: Documenting patient health goals and care preferences.
- Medication: Focusing on medication management, including reviewing medications using guidelines like the Beers Criteria.
- Mentation: Identifying and managing cognitive issues like dementia, depression, and delirium.
- Mobility: Promoting safe movement and physical activity.
The Five Domains of the CMS Age Friendly Hospital Measure
The measure requires hospitals to attest to implementing practices within five specific domains:
- Eliciting Patient Healthcare Goals: Having protocols to document patient goals and preferences.
- Responsible Medication Management: Using evidence-based protocols to review and manage medications.
- Frailty Screening and Intervention: Screening for frailty-related issues and planning care accordingly.
- Social Vulnerability: Screening for social risks and connecting patients to resources.
- Age-Friendly Care Leadership: Establishing dedicated leadership to oversee age-friendly care implementation.
Benefits of the Age-Friendly Rule
Implementation leads to more personalized care and better patient outcomes. Hospitals may also experience reduced lengths of stay and lower costs. Public reporting will provide transparency for patients and caregivers.
| Feature | CMS Age Friendly Rule (Effective 2025) | Standard Hospital Care (Before 2025 Measure) |
|---|---|---|
| Focus | Holistic, patient-centered geriatric care based on the 4Ms. | Often disease-specific or episodic, without a comprehensive, standardized focus on geriatric issues. |
| Screening | Mandatory screening protocols for frailty, cognition, mobility, and social vulnerabilities. | Screening for geriatric syndromes was inconsistent and not a required part of quality reporting. |
| Leadership | Requires a dedicated leader or committee for age-friendly care prioritization. | Lack of a required, centralized leadership structure to ensure consistent geriatric care quality. |
| Payment Impact | Tied to Medicare's Inpatient Quality Reporting (IQR) program; non-compliance risks payment reduction. | Medicare payment incentives were not tied specifically to the implementation of age-friendly structural protocols. |
| Goal of Care | Protocols to explicitly elicit and align treatment with the patient's healthcare goals. | Often emphasized disease-based treatment plans over personalized, goal-concordant care. |
| Visibility | Public reporting on CMS Care Compare website allows public scrutiny. | Lack of transparency regarding hospitals' overall age-friendly capabilities. |
Conclusion
The CMS Age Friendly Rule is a crucial step to improve hospital care for older adults by integrating evidence-based geriatric practices into quality reporting. Based on the 4Ms framework and requiring adherence to five domains, the rule aims to enhance outcomes, reduce harm, and deliver patient-centered care. Hospitals must prioritize the needs of older patients through leadership, systematic screening, and aligning care with patient goals, with public reporting ensuring accountability and transparency. This initiative promotes high-quality age-friendly care for older adults.
Frequently Asked Questions
How does the Age Friendly Hospital Measure affect Medicare payments?
Hospitals participating in Medicare's Inpatient Quality Reporting (IQR) program must report on this measure to receive their full annual Medicare payment update. Non-compliance can result in a significant financial penalty.
What are the 4Ms of the Age-Friendly Health Systems framework?
The 4Ms framework for geriatric care focuses on What Matters (patient's goals), Medication (responsible management), Mentation (cognition and mood), and Mobility (safe, daily movement).
When does the CMS Age Friendly Hospital Measure go into effect?
The mandatory reporting for this measure began on January 1, 2025.
Is the CMS Age Friendly Rule a voluntary program?
No, it is mandatory for all hospitals participating in the Medicare Inpatient Quality Reporting (IQR) Program.
What are some examples of age-friendly care leadership requirements?
Leadership requirements include designating a champion or committee, prioritizing age-friendly issues, providing staff education, and reporting relevant data to leadership.
How can patients and caregivers find out if a hospital is age-friendly?
Reporting on this measure is publicly available on the CMS Care Compare website.
What is considered a potentially inappropriate medication (PIM) for older adults under this rule?
Under the Medication domain, hospitals must use guidelines like the Beers Criteria to identify and manage medications that may be inappropriate or high-risk for older adults.
