Authors
Omar Amir, Martine Sanon
Published in
NEJM catalyst innovations in care delivery. Volume 7. Issue 11. Pages CAT260343. Epub Oct 21, 2026.
Abstract
As the Age-Friendly Health Systems (AFHS) movement enters a new phase of policy integration, hospitals face a pivotal moment. The U.S. Centers for Medicare and Medicaid Services (CMS) Age Friendly Hospital Measure has created regulatory conditions necessary for hospital systems to institute high-quality, personalized care for older adults. As the CMS is expected to transition from pay-for-reporting to pay-for-performance for age-friendly care in the coming years, health systems must urgently move beyond reporting compliance toward true care redesign. The authors highlight three interrelated strategic risks and challenges that hospital leaders and executives must navigate in the current environment. First, there is the danger of reducing age-friendly care processes to siloed checklist exercises to satisfy reporting requirements, a risk that hospitals must mitigate by ensuring age-friendly care bundles are implemented as synchronized, outcome-driven approaches that respond to changes in the clinical status of patients and their transitions of care. Second, hospitals must account for older adults who are suffering from complex care needs, or multicomplexity, particularly because these patients disproportionately drive high costs and utilization metrics. Hospitals with constrained resources may also treat the 4Ms (What Matters, Medication, Mentation, and Mobility) framework as a substitute for specialized care, shifting investment away from geriatric specialists, palliative care practitioners, and allied interdisciplinary teams. Third, given the profound shortage of geriatric expertise, health systems must accept that they cannot provide specialist-level care to every patient 65 years of age or older. Even well-resourced health systems often struggle with risk-stratification blindness, failing to distinguish between universal age-friendly interventions appropriate for all inpatients and the subset of patients who require more intensive care with interdisciplinary geriatric teams. Without clear risk stratification, implementation efforts may become fragmented, inefficient, and difficult to sustain. To mitigate these risks, the authors propose a risk-stratified, three-tier operational framework that hospital leaders can utilize for age-friendly system redesign. This paradigm treats the 4Ms and other geriatric care processes enshrined in the CMS Age Friendly Hospital Measure as a foundation that should be delivered to all hospitalized older adults 65 years of age or older. It then builds on this foundation to identify strata of higher-risk older adults who require greater resource allocation, ranging from specialized interdisciplinary programs and protocols (such as hip fracture protocols and Geriatric Surgery Verification), which can be delivered primarily by generalists with geriatrician oversight, to higher-intensity models of care (such as acute care for elders units or geriatric-surgical comanagement), which require more intensive involvement from specialist geriatric teams. This operational roadmap will help hospital systems better match limited geriatric workforce resources to patient complexity, reducing inefficient care and improving both clinical and operational outcomes in alignment with the triple aim of health care.
PMID:
42904679
Bibliographic data and abstract were imported from PubMed on 23 Oct 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 7
- Comments 0