Understanding the Core of the CMS Age Friendly Structural Measure
The CMS Age Friendly Structural Measure promotes evidence-based care for older adults and is part of the Inpatient Quality Reporting (IQR) program. This structural measure evaluates a hospital's commitment and capabilities rather than patient outcomes directly. It is an attestation-based tool where hospitals confirm they have structures and processes for older patients, based on the Age-Friendly Health Systems 4Ms Framework. The 4Ms Framework focuses on What Matters, Medication, Mentation, and Mobility.
The Five Domains of the Measure
Hospitals must attest to five domains related to geriatric care and the 4Ms Framework. Hospitals must attest 'yes' to all sub-questions within a domain to receive credit.
- Eliciting Patient Healthcare Goals: Capturing patient goals and preferences for shared decision-making.
- Responsible Medication Management: Reviewing and optimizing medication for older adults.
- Frailty Screening and Intervention: Screening for frailty, cognitive issues, mobility, and malnutrition.
- Social Vulnerability: Screening for social needs and connecting patients with community resources.
- Age-Friendly Leadership Commitment: Having dedicated champions or committees.
The Role of the 4Ms Framework
The five domains align directly with the 4Ms Framework:
- What Matters: Aligned with patient goals.
- Medication: Covered by Responsible Medication Management.
- Mentation: Included in Frailty Screening and Intervention (cognitive impairment, delirium).
- Mobility: Also part of Frailty Screening and Intervention (maintaining mobility, preventing falls).
How the Measure Impacts Hospitals
Participating hospitals face implications from the Age Friendly Structural Measure.
Comparison of Structural vs. Outcome Measures
| Feature | Age-Friendly Structural Measure | Traditional Outcome Measures |
|---|---|---|
| Focus | Commitment and capabilities (e.g., processes and policies) | Results of care (e.g., mortality rates, readmissions) |
| Evaluation Method | Attestation-based reporting by the hospital | Data collection from patient records and other sources |
| Actionable Insight | Identifies underlying organizational weaknesses | Highlights areas of poor performance |
| Immediate Impact | Drives establishment of new programs and processes | Shows the final result, not the cause |
| Example | Designating an age-friendly champion | Rates of hospital-acquired infections (HAIs) |
Implementation and Reporting Requirements
Hospitals report annually through the QualityNet Secure Portal. Successful attestation involves:
- Gap Analysis: Evaluate existing processes.
- Implementation Plan: Develop a plan.
- Staff Training: Train staff.
- Leadership Engagement: Ensure dedicated leadership support.
- Data Management: Utilize systems to track and report.
Consequences for Compliance and Non-compliance
Failure to report can lead to reduced Medicare payments. Compliance can lead to public reporting on Medicare Care Compare.
Conclusion
The CMS Age Friendly Structural Measure is a key step in improving geriatric care in U.S. hospitals. By focusing on structural, attestation-based criteria aligned with the 4Ms Framework, it encourages hospitals to develop foundational processes for high-quality care. This measure's focus on patient goals, medication management, functional screening, social needs, and leadership ensures a comprehensive approach to the needs of older adults. Meeting these requirements benefits hospitals by potentially improving patient outcomes, reducing costs, and enhancing their reputation. While it requires internal changes, the long-term advantages for both patients and organizations are significant. {Link: Centers for Medicare & Medicaid Services https://www.cms.gov/medicare/quality/initiatives/hospital-quality-initiative/inpatient-measures}
