votingOnce again I want to call the Hartford community (all of the grantees, fellows, scholars, alums, and friends) to respond to an opportunity to put geriatrics expertise to work.

The Centers for Medicare and Medicaid Services (CMS), the 900-pound gorilla with a checkbook whose actions shape so much of health care for older adults, and its relatively new transformation arm the Center for Medicare and Medicaid Innovation (CMMI), are requesting input from the public on how to achieve large scale transformation of clinician practices. This input will help guide CMS’s policy considerations and potentially lead to the testing of new payment and service delivery models.

Sometime early in March (I almost missed it), CMMI issued a Request for Information (RFI) on Transforming Clinical Practice in which they ask for advice on the processes needed to make truly radical change in health care. The deadline for submitting comments is April 8.

Reading between the lines, I believe the focus is on outpatient office practice with an emphasis on primary care and patient-centered medical home transformation. (The RFI announcement cites a recent Commonwealth Fund report authored by Ed Wagner and others on the factors that seem to facilitate implementation of medical home principles across a Commonwealth-funded, safety-net collaborative.)

As I understand it, the bottom line question is how can CMMI replicate the very broad-scale quality improvement efforts that have been undertaken through the $218 million dollar Hospital Engagement Network initiative under the banner of the Partnership for Patients. In this initiative CMMI gave grants to hospital networks and American Hospital Association branches to reach out to 3,700 participating hospitals with the intention of reducing a list of 10 harms (e.g., pressure ulcers, surgical site infections, etc.) by 40 percent and all-cause readmissions by 20 percent. Although I have yet to see any publicly reported results of the effort, I gather it is considered enough of a success to be worth trying to repeat in primary care.

The RFI lists 36 questions, such as:

#10 Which existing educational and assistance efforts might be examples of “best in class” performance in spreading the tools and resources needed for practice transformation? What evidence and evaluation results support these efforts?

#5 What key areas of practice transformation require attention?

#16. What are the most significant clinician challenges and lessons learned related to transforming a practice and what solutions have been successful in addressing these issues?

I am sure that the experts in care of older adults who have enormous experience in teaching others about high-quality geriatric care, developing and disseminating new models of care, and working within health systems to change practice all have something to contribute to this effort. For all of the expertise inside CMS/CMMI and Ed Wagner’s national leadership in chronic care, the one thing this RFI leaves out is anything about the particular needs of the high cost and poorly served older adult Medicare population.

You would think that CMS would be concerned with a population that accounts for between 25 and 35 percent of outpatient primary care visits, and a far greater share for many specialties. You might think that the failure to effectively manage the chronic diseases that unfortunately are more common among older adults, and in turn drive high rates of ambulatory care sensitive hospitalizations in the Medicare population, might make care of older adults a particular interest.

But it doesn't seem so.

While plenty of CMS announcements make it to my in-box, this one didn't turn up because it includes nothing about aging, geriatrics, multiple chronic illness, long-term care, end-of-life or any other terms my automated Google searches return to me each morning.

Therefore, I think the geriatrics and gerontology community have a vital role to play. Give CMMI your best advice on what clinical issues and what processes should be used to drive widespread improvement in primary care in the United States – including but not limited to the care of older adults.

You don’t have to answer all the questions and each answer can be no more than 2,000 characters. They ask that we give evidence and be specific where possible. You can also upload up to a five page document (see the end of the online form). The online submission form can be found at http://www.healthcarecommunities.org/Home/RFI-TransformingClinicalPractice.aspx.

When you submit your responses to CMMI, please also submit them to our Health AGEnda blog as a comment or send them to me as an e-mail (christopher.langston@jhartfound.org) with "CMMI Transformation Comments" in the subject line. We will post all of the comments we get and share them with the entire Change AGEnts community.

I think it will be interesting to have a chance to see what goes into the otherwise opaque process of CMMI decision making. And it will be interesting to see where we agree among ourselves and where we have a diversity of opinion. If CMS won’t take your suggestions, I know that we can put them to good use ourselves.

So give your input. Your comments count.