The Centers for Medicare & Medicaid Services (CMS) released a new Age Friendly Hospital Measure Thursday based on work by the American College of Surgeons (ACS) and designed to improve the care and outcomes of older adult patients. This measure, which becomes effective January 1, 2025, will help hospitals provide high-quality, patient-centered care for older adults by driving improvement in five key areas.  

All hospitals participating in the Hospital Inpatient Quality Reporting Program (IQR) must report on their compliance with the measure and could face significant financial penalties if they fail to do so. The measure will be reported on the CMS Care Compare website to allow patients and caregivers to know which hospitals deliver age-friendly care for seniors.  

The ACS led the development of the Age Friendly Hospital Measure in collaboration with the Institute for Healthcare Improvement (IHI) and the American College of Emergency Physicians (ACEP) with support from The John A. Hartford Foundation.  

This new type of “programmatic” measure is developed principally based on the standards of the ACS Geriatric Surgery Verification (GSV) Program, launched in 2019 to meet the specific needs of older adult patients undergoing surgery. The ACS GSV program is grounded in scientific evidence and provides hospitals with proven ways to improve such things as postoperative delirium-related complications, reduce readmissions costs, and enhance patient quality of life. Using GSV, a hospital can reduce the average length of a patient’s stay — generating significant cost savings while helping patients achieve their care goals. The ACS is offering a new level of the GSV specifically tailored to address the five domains included in the measure.  

"The creation of the Age Friendly Hospital Measure represents a significant step forward in recognizing the unique needs of older patients. We are proud to be strong advocates for this new measure because we are confident that it will lead to improved care and outcomes for this patient population,” said ACS Executive Director & CEO Patricia L. Turner, MD, MBA, FACS. “The ACS GSV Program will help hospitals meet these new requirements, and will also help them improve care, shorten the length of stay for many patients, and reduce the costs for the delivery of care.”  

Improving Older Adult Care 

Meeting the complex care needs of older adults has become a more urgent imperative, given the dramatic increase in this population expected in the coming decades. The number of Americans over the age of 65 will more than double over the next 40 years, topping 80 million by 2040. Today, patients 65 years and older account for more than 40% of all inpatient operations — a number that is expected to grow. 

"With the aging and expanding population, hospitals are seeing significant increases in the number of older adult patients who routinely have additional care needs that we haven’t always effectively addressed. Our Geriatric Surgery Verification Program, or GSV, gives hospitals a proven and feasible way to deliver superior care, reduce complications, and improve overall outcomes for these patients. Importantly, the GSV gives hospitals the tools to deliver this higher quality of care more efficiently, translating to lower costs,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Director of the ACS Division of Research and Optimal Patient Care. “One of the biggest challenges hospitals have is addressing postoperative delirium which occurs in 25% of patients, costs a hospital about $20,000 per episode, and greatly impacts patients and caregivers. The GSV program provides effective strategies to reduce the chances of delirium which leads to fewer days in the hospital, improved outcomes for patients, and significant cost savings.”  

The Age Friendly Hospital Measure will evaluate hospitals’ progress toward improving care for patients aged 65 and above across various settings, including hospital wards, operating rooms, and emergency departments. The measure is structured into five domains:  

1. Eliciting Patient Healthcare Goals: Ensures patient health-related goals and treatment preferences are obtained to inform shared decision-making. 
2. Responsible Medication Management: Optimizes medication management by monitoring pharmacological records to avoid inappropriate drugs for older adults. 
3. Frailty Screening and Intervention: Screens for cognitive impairment (including delirium), mobility, and malnutrition, allowing for early detection and intervention. 
4. Social Vulnerability: Recognizes and addresses social issues impacting older adults as part of the care plan such as social isolation, economic insecurity, ageism, caregiver stress, limited access to healthcare and elder abuse.  
5. Age-Friendly Care Leadership: Identifies an age-friendly champion or committee in the hospital to ensure compliance with all components of the measure. 

Collaboration and Support 

The ACS, IHI, and ACEP worked collaboratively over the last few years to bring this measure to fruition, believing that it will better position hospitals to care for this growing population.  

"We are grateful for the strong collaboration with IHI, ACEP, and The John A. Hartford Foundation to advocate for this measure with CMS. Our work together highlights how we can partner with CMS and other leading organizations to design new, evidenced-based, and impactful quality measures that will lead to meaningful improvement in the care our older patients receive,” said Dr. Ko.

“Every older person who visits a hospital deserves and should demand age-friendly care that is centered on what matters to them,” said Terry Fulmer, PhD, RN, FAAN, president, The John A. Hartford Foundation (JAHF). “With this essential new measure of quality in the Medicare program, hospital leadership will now publicly report on how well they address the most critical factors affecting the health outcomes of older adults, including their medications, mentation and mobility in the context of social vulnerability. The great news is that we philanthropically support programs that can help every hospital say ‘yes’ when they are asked if they deliver age-friendly care.”