The Hardest Job To Fill (And Keep) – CMS Chief

March 12, 2012 By Leave a Comment

President Obama is fighting to save his signature health law on two fronts: in the Supreme Court and on the campaign trail, where Republican candidates are promising to kill the Affordable Care Act.

Photos by Getty Images and Associated Press

 Yet even if the president prevails, he faces another daunting challenge: implementing the law in a seamless, timely manner. The Centers for Medicare & Medicaid Services is charged with making the health law work, drafting regulations, setting up new programs and providing oversight. But for years Congress has undermined the agency’s leadership and potential effectiveness, raising questions about its capabilities and resources even as the health law ramps up its responsibilities.

For starters: consider the revolving door leadership at CMS.

Since its creation in 1977 as the Health Care Financing Administration, the agency has had 29 administrators in 35 years – an average tenure of just 14 months. The longest-serving administrator held the job for four years and five months. The shortest: two months.

The most recent CMS administrator, Dr. Donald Berwick, resigned in December after 16 months. His replacement, Marilyn Tavenner, currently holds the title of acting administrator. That’s hardly uncommon.

Acting administrators have run the agency 20 percent of the time. And the trend appears to be increasing: the Senate hasn’t confirmed a full-time CMS administrator since 2006, when Mark McClellan resigned midway through the second Bush administration.

“Imagine if somebody went two years without a Secretary of Defense,” Thomas A. Scully, who was CMS administrator under President George W. Bush, told the journal Health Affairs in April 2010.

For decades, government and private researchers have pointed to a widening gap between the agency’s responsibilities and resources. As the largest purchaser of health care in the world, with a budget of $820 billion, CMS pays for the care of one in three Americans, and interacts daily with thousands of hospitals, doctors and other providers.

4,900 vs. 62,000 Employees

The number of Medicare and Medicaid beneficiaries has soared since the programs started in 1966, with tens of millions of Baby Boomers and uninsured expected to swell the rolls even more in coming years. Yet today the agency has the same number of employees it had during the during the Carter administration – about 4,900.

By comparison, the Social Security Administration, with a smaller budget, has 62,000 employees. Even including work that CMS outsources to private contractors – bill-paying, coverage decisions and quality oversight – the agency operates with about half as many employees as Social Security.

The shortages have hurt the agency’s ability to implement crucial reforms, ensure adequate oversight of hospitals and other providers and find ways to stem spiraling medical costs, researchers say. For years, CMS executives weren’t even sure if they could consider cost as part of their coverage decisions, paying high-quality and low-quality providers the same amount.

In 1999, a bipartisan group of former administrators and health policy experts wrote an open letter to Congress decrying “the mismatch” between the agency’s resources and its “mammoth assignment.”

Three years later, the nonprofit National Academy of Social Insurance wrote, “This mismatch has grown worse in recent years as CMS’ responsibilities have increased dramatically.”

“Really, when you consider what they have to work with, they do a fairly remarkable job,” adds Robert A. Berenson, a former CMS administrator, and now a health researcher at the Urban Institute. “Assuring adequate staff at CMS has not been a priority for Congress even though it might more than pay for itself in more efficient programs.”

‘What’s Missing Is … A Consolidated Strategic Vision’

Berwick, a physician and national expert on health quality, said he was “impressed and gratified” by the way senior staff rallied around his calls to implement the sprawling health law. But much of staff time is taken up writing rules and regulations.

Career executives “perform these core components well,” said Berwick. “What’s missing is a kind of coherence and consolidated strategic vision of where to head next.”

In recent years, Congress has added more programs and complex legislation to the agency’s plate, including overseeing a 2003 prescription drug benefit for seniors, ensuring patient privacy, helping to weed out waste and fraud and developing a system for grading hospitals and nursing homes.

The Obama administration’s nearly two-year-old health law adds yet more duties: helping to oversee insurance exchanges in 50 states, operating a program to spur ways of delivering care more efficiently, and guiding big expansions of Medicare and Medicaid, the agency’s core programs.

CMS will be expected to do so even as “frequent changes” at the top “have inhibited the implementation of long-term Medicare initiatives or the pursuit of a consistent management strategy,” according to a 2000 study by the U.S. General Accounting Office.

For years, the agency was criticized for focusing more on getting checks out to hospitals and doctors than ensuring quality or finding ways to trim health spending. Part of that had to do with Medicare’s unique history. For the first 11 years of its existence, the program was housed in the Social Security Administration, which issues monthly income support checks to retired Americans.

But even after the Medicare and Medicaid programs were put under one roof in 1977, the agency continued to struggle, facing criticism from Congress and medical providers. “It’’s almost paradoxical the extent to which Medicare is so important and valued in the lives of so many families and communities, and the overwhelming communication the people running the program get is hostility,” said Bruce Vladeck, an administrator in the Clinton administration.

Not Just A Check-Writing Agency

Gail Wilensky, who ran the agency for two years under President George H.W. Bush, said CMS has evolved into a much more sophisticated operation. “It’s not just a check-writing agency anymore,” she said. But the turnover at the top sends the wrong message to employees, who respond by being “more inward and protective.”

The CMS administrator’s position is a political appointment requiring Senate confirmation. Berwick’s name surfaced as a potential CMS leader shortly after Obama’s election. A pediatrician by training, Berwick gradually shifted his focus to quality improvement, steering the nationally recognized Institute for Healthcare Improvement, a nonprofit based near Boston.

The Obama administration waited to submit his name for the CMS position until April 2010, one month after it won passage of the Affordable Care Act. By then, Republicans were openly attacking the legislation as unduly burdensome and costly. Berwick never did get a Senate hearing and was appointed by the president during the congressional recess that July.

The recess appointment avoided what many predicted would be a losing battle with Senate Republicans. Some of them accused Berwick of promoting rationing, based on favorable comments he had made in the past about the British National Health System. Sen. Pat Roberts, R-Kan., said Berwick’s focus on cutting costs would lead to a rural health system consisting “of a Band-Aid and a bed pan.”

In an interview, Berwick said Republicans “twisted and distorted” his words and used the agency as “a political football. It’s a game to them,” he said. Berwick added that the churn in administrators “demoralizes and confuses” senior staff and hurts the agency’s ability to develop a consistent long-term vision. “What happens, I think, when you have a lot of turnover is senior staff loses its confidence and is less willing to take risks.”

Wilensky said she was “especially frustrated” with what happened to Berwick. “I like Don Berwick. I don’t always agree with him but I have a lot of respect for what he has done and for his passion for the great issues he takes on.”

Berwick had little choice except to resign. His acting term was set to expire at the end of 2011 and 42 Republican senators had already announced their intentions to block his confirmation as a full-time administrator. The administration nominated Tavenner, a former Virginia health official and executive with the for-profit Hospital Corporation of America, just days later.

Several prominent Republicans, including Republican House Majority leader, Eric Cantor, said Tavenner was “eminently qualified” to run the agency. But months later Tavenner still hasn’t gotten a hearing and, with the heated politics of an election year, some wonder if she will.

 

 

By Gilbert M. Gaul Kaiser Health News

This story was produced in collaboration with The Washington Post

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CMS Selects Nurses to be “Innovation Advisers”

January 25, 2012 By Leave a Comment
A New York hospital is testing a new approach to fight obesity. A Boston hospital wants to try a new nursing model. A Montgomery County primary-care clinic plans to expand its pharmacy program that gives one-on-one medication counseling to patients with chronic illnesses.The people who created these programs are among the first 73 “innovation advisers” chosen by federal health officials this month to experiment with ways to provide better health care and reduce costs. Funded with $6 million from the health-care overhaul act, the initiative is one of the first programs of the new Innovation Center at the federal Centers for Medicare and Medicaid Services, known as CMS.
The advisers are meeting in Baltimore starting Monday for initial training and orientation as part of a year-long commitment, officials said. The health professionals include doctors, nurses, hospital executives and public health and policy experts from institutions in 27 states and the District. The home organizations receive stipends of up to $20,000 to cover some of the costs, such as travel.In the Washington region, the professionals include Rosemary Botchway of the Primary Care Coalition of Montgomery County; Stephanie Bruce, a geriatrician at Washington Hospital Center; and Len Nichols, a health economist at George Mason University.The overall goal of the CMS Innovation Center is to find new ways to improve health and lower costs, said Joe McCannon, a senior adviser. “That’s the North Star for every program we’re introducing,” he said.Some Republicans have questioned the value of investing in experimentation to produce results at a time of limited resources.Under the program, the advisers work on projects in their respective institutions. The goal is for them to become change agents at their home organizations, while also providing CMS officials with new ideas and approaches. CMS will work with them through the year to refine the projects and help “get some traction,” McCannon said. If the projects are successful, the ideas could then be applied more broadly, such as to Medicare and Medicaid.

Officials intend to select a second group of advisers in the spring, for a total of about 200 professionals. [Read more...]

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House Rejects Senate Tax Measure – Physician Pay Cut Looms

December 21, 2011 By Leave a Comment

The threat of a 27.4% cut to Medicare physician payments Jan. 1 became more real Tuesday after the House of Representatives voted 229-193 on a motion to disagree with a Senate-amended version of a House payroll tax cut bill that would have placed a two-month freeze on payments to the nation’s doctors.

In that same vote, the lower chamber requested a conference, which would allow the House and Senate to resolve their differences in the two bills. On Saturday, the Senate approved an amended version of a House payroll tax cut bill that the House passed Dec. 13. Both pieces of legislation would avert the scheduled reduction in Medicare physician payments and extend certain healthcare provisions that are set to expire by year’s end. But while the House version calls for a two-year fix to the sustainable growth-rate formula and provides a 1% update for doctors in 2012 and 2013, the Senate’s amended legislation would place a two-month freeze on physician payments until Feb. 29.

House Speaker John Boehner (R-Ohio) and Majority Leader Eric Cantor (R-Va.) have said a two-month extension of the payroll tax holiday is inadequate, and continue to push for a full-year extension. But Senate Majority Leader Harry Reid (D-Nev.) said Monday that before negotiations are re-opened on a yearlong extension of the payroll tax cut, the House must first pass the compromise that had been negotiated with Republicans.

“Regardless of whether Congress will retroactively make up this devastating loss of practice income next year, federal lawmakers’ failure to act will cause grave disruption in physician practices,” Dr. Glenn Stream, president of the American Academy of Family Physicians, said in a statement. “Nearly one in four patients seen by family physicians is a Medicare beneficiary. For some family physicians, Medicare patients comprise as much as eight in 10 of their patients. No business can sustain such immediate and draconian cuts to their revenue.”

Related content from 12/17: Senate OKs two-month freeze on doc pay
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CLASS Dismissed: Administration Pulls Plug On Long-Term Care Program

October 17, 2011 By Leave a Comment

Federal officials on Friday effectively shut down part of the health care law that would have helped consumers cover some long-term-care costs, saying they could not find a way to make it work financially.

After looking at a variety of options, the Obama administration determined the Community Living Assistance Services and Supports (CLASS) Act program could not simultaneously meet three important criteria: be self-sustaining, financially sound for 75 years and affordable to consumers.

The move does not affect the rest of the health care law, although it does remove more than $70 billion in expected federal budgetary savings over 10 years.  The savings would have come having policyholders pay premiums for the first few years, but not receive benefits until 2017.

The program – championed by the late Sen. Edward Kennedy – would have allowed working adults to apply for insurance that would provide up to $50 a day in cash benefits if they became disabled. The money could be used to help with in-home assistance or nursing home care.

While acknowledging the need for such long-term-care assistance, the program’s administrator, Kathy Greenlee, said Friday that the numbers just didn’t add up.

Under one scenario shown in a report sent to Congress Friday, administration analysts said a basic CLASS insurance plan with a $50 a day benefit might have cost $235 to $391 month.  That might have been more than consumers would have been willing to pay based on the benefit. If enough people did not voluntarily enroll, the program would not have been self-sustaining.

“The overall program could not run if it had a highly priced solvent product no one would buy,” said Greenlee, administrator of the Community Living Assistance Services and Supports (CLASS) program.

Republicans had slammed the CLASS since its inception, describing it as a scheme that would require policyholders to pay into a program whose costs would quickly surpass its revenues.  Recently, Hill Republicans had asked for a congressional hearing into the program and had released a report that concluded HHS officials ignored warnings about its sustainability.
[Read more...]

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Medicare Plans See Dollars In Quality Rating Stars

October 12, 2011 By Leave a Comment

Three Boston-area health insurers are in a race for a decisive competitive advantage. They’re not seeking the usual industry plaudits, exclusive deals with high-profile medical providers, or splashy marketing campaigns.

They’re after the highest mark on Medicare’s quality exam, a one-to-five star rating system that was an afterthought until the 2010 health law tied it to big cash bonuses.  The Medicare Advantage plans’ latest ratings for 2012 will be released Wednesday. Top scoring plans will also win the ability to enroll new members year-round, rather than a few weeks each autumn.

“It’s a huge game changer in Massachusetts,” said Ken Arruda, executive director of Medicare services for Blue Cross Blue Shield of Massachusetts, which currently has 4.5 stars. Also in the Boston area, Fallon Community Health Plan and Tufts Health Plan are on the cusp of the top score. Each says their strategy is to reach five stars as soon as possible –a feat only three plans nationwide have achieved so far.

Competition is fiercest in places like Boston, where high-ranking plans are near their goal, but shades of this quality arms race are visible throughout the country. Insurers have rarely competed on quality measures, but as the federal government prepares to unleash an estimated $3 billion to $4 billion next year in bonus payments, the industry is following the money. Star-ratings are bleeding into bottom lines, board meetings, and corporate strategy as the insurers chase top scores.

Wednesday’s announcement comes just ahead of the open enrollment period which runs from Oct. 15 through Dec. 7. About one quarter of Medicare beneficiaries are now in private plans that contract with the federal government to provide health benefits to seniors and disabled people.

The star ratings have been on the books since 2007 and are the only guide to health plan performance available to consumers. Next year, though, is the first in which there is money at stake for the companies.

“To say that the [private plans] put less than optimal resources toward star quality ratings in the past would be an understatement,” wrote Barclays Capital analyst Joshua Raskin. Now, he said by e-mail, he sees a “clear effort on improving the ratings at most companies.”

The federal health law cut $136 billion in payments to Medicare Advantage plans over 10 years, and health plan accountants increasingly see the new star-rating bonuses as a way to mitigate the losses.

The Obama administration has argued that the private plans, originally devised as a way to reduce Medicare costs, have long been overpaid. They cost the government as much as 114 percent of the cost of traditional Medicare patients, without producing better health outcomes for enrollees. The federal government announced in November that it would increase the bonuses. The program is part of a push for quality, led by Medicare administrator Dr. Donald Berwick, that is meant to boost results even as the cuts kick in.

Consumer advocates, such as Ilene Stein, the Medicare Rights Center’s federal policy director, are hopeful that the ratings will improve quality for Medicare beneficiaries. However, Stein cautioned, the Medicare agency will need to oversee the bonus system so health plans don’t game the measures.

Beginning in January, plans with three stars – the average rating – or better, will get bonuses of 3 to 5 percent of their total Medicare payments.  The ratings are based on 36 measures, ranging from diabetes care to the volume of consumer complaints. Twenty-two insurers across the country now boast a 4.5 star rating. Of 396 plans that received 2011 scores, only three achieved five stars: one each in Colorado, Florida and Wisconsin.

Attention to the ratings is new even to the top performers. At Marshfield Clinic’s 5-star Security Health Plan in Wisconsin, the plan’s top administrative officer, Steve Youso, described the high score as a natural byproduct of the insurer’s culture of quality.

But, now executives there are paying attention, too, knowing the top rating is worth keeping. “Prior to March 2010″ – when the health law passed – “[ratings were] probably not a topic of discussion,” Youso said. Now, “our senior executive team is talking about this on a weekly basis.”

There’s a similar dynamic at Massachusetts’s Fallon Community Health Plan, which is still gunning for five stars. “The finance department is more interested in our [quality] results than ever before,” said Ann Marie Sciammacco, vice-president of health services. “Basically, the stars equate to dollars.”

In Worcester County, the hub of Fallon’s service area, five-star plans would earn $8 a month more than 4.5 star plans for a typical member, according to Medicare data. For Fallon’s 28,000 members there, it would add up to $2.7 million a year – money that could be used to reduce premiums and attract more customers.

Sometimes boosting ratings is simple work. One measure the government tracks is the rate of colorectal cancer screening for certain patients. Fallon members get a birthday card from their insurance company that reads, “Every nine minutes, someone in the U.S. dies from colorectal cancer.” Eighty-four percent of Fallon patients get the screening.

Fallon – or a rival plan in the Boston-area – could also benefit from the year-round enrollment perk, which would allow a five-star plan to pick off its competitor’s members.  ”The primary – but untested in this market – competitive advantage of being five stars… is the ability to enroll year round,” said Richard Burke, Fallon’s president of senior care services, in an e-mail.

Nationally, lower ranking insurers, such as the publicly traded HealthSpring, which runs mostly three-star plans, view star ratings as a crucial ingredient to boosting revenues and competing more effectively. Jason Feuerman, a top HealthSpring executive, said in an April interview, “We’re putting the resources in place to make sure we can drive those ratings.”

During a visit that month to a HealthSpring-operated clinic in Philadelphia, administrator Nathaniel Decker pointed out equipment, such as a digital retinal camera, that he said was installed to help boost star ratings by allowing doctors to easily perform one of the tasks measured: eye exams for diabetic patients.

In addition to missing out on the bonuses, plans that consistently score less than three stars could eventually be booted from the program altogether under a proposed regulation released early this month by the Medicare agency.

Plans’ interest in boosting ratings is widespread enough to fuel a niche consulting business. The consulting arm of OptumInsight, a subsidiary of UnitedHealth Group, for instance, says it has picked up 35 health plan clients seeking star-related services. “As soon as you start attaching some money to it, it’s amazing,” said Steve Wood, an Optum management consultant.

In some markets, the star ratings could boost underdogs. Houston-based KelseyCare Advantage, a Medicare plan affiliated with the Kelsey-Seybold Clinic, is on the cusp of a five-star rating. In membership, though, it trails TexanPlus, a Medicare plan operated by the publicly-traded Universal American Corporation, that has 50,000 members – twice as many as KelseyCare. But TexanPlus has only 3.5 stars this year.

KelseyCare President Marnie Matheny is hoping to achieve five stars – and a marketing edge that could level the playing field with a competitor who can do things like rent out the Reliant Center for a Wii bowling tournament to attract customers.

“It will be huge for us,” said Matheny. When patients see “there’s no one else in the market [with five stars], they’ll think there’s something special about KelseyCare.”

 

Article By Christopher Weaver a KHN Staff Writer.  Kaiser Health News

 

 

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CMS Administrator Berwick says CMS has the Money to Establish Health Insurance Exchanges

September 12, 2011 By Leave a Comment

CMS Administrator Dr. Donald Berwick told reporters Monday that the CMS has the money necessary to move forward in establishing health insurance exchanges.

“We have every intention of running the exchanges on time and helping states do the same,” Berwick said following his remarks at the America’s Health Insurance Plans conference on Medicare and Medicaid, which runs through Sept. 15. “There will be federal exchanges, of course. Some states will choose that as a better way for them,” he added. We don’t know how many.” When pressed for whether the CMS has the funding required to establish these insurance marketplaces, Berwick said: “Step by step, we have the money we need now to take the next steps.”

Meanwhile, Berwick said the selection process for the Pioneer ACO model—the sister program to the Medicare Shared Savings Program for accountable care organizations—is under way. Berwick said the application process, including even the number of applicants for it, is confidential, and that he suspects the CMS will announce the Pioneer ACOs before the MSSP program begins in January.

In his keynote speech earlier, Berwick emphasized that the cost of healthcare is a “center-stage issue” and one that can be addressed in two ways: either by cutting care, which he noted is “seductively easy,” or by improving care, which he said is not only the better option, but one that is within reach.

There are “direct savings policies” that reduce costs even if there are no changes in provider or patient behavior, such as changes to the level of payment to providers and productivity adjustments that he said are easy to quantify. But those policies are less than ideal and “certainly not the best route to the better healthcare that we all seek,” Berwick said. Instead, the focus should be on the “indirect savings policies,” which are ways to work with stakeholders to reduce the waste in the healthcare system.

Berwick outlined six major types of healthcare waste: failures to coordinate care; failures in the care process (such as delays or producing injuries); over-treatment; excessive administrative costs; problems in healthcare pricing; and fraud and abuse.

Read more at: Modern Healthcare . Story by By Jessica Zigmond
**Would you like to learn more about what an ACO (Accountable Care Organization) is?  Here is an article to read ACO FAQs by Kaiser Health News.
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Doctors Voice Concerns About CMS’ Physician Compare Site

May 9, 2011 By Leave a Comment

Physicians are finding a number of biographical data errors on CMS’ Physician Compare website and are questioning whether patients can trust the accuracy of the site, American Medical News reports.

Background

In December 2010, CMS launched the Physician Compare site to provide consumers with data such as a physician’s name, address and Medicare participation status.

In 2013, CMS plans to publish physicians’ quality performance data, based on the prior reporting year. CMS Administrator Donald Berwick said the quality information on physicians will be similar to how Medicare provides data on hospitals and nursing homes.

Error Details

Physicians say common errors found on the site include:

  • Name misspellings
  • Incorrect Medicare participation status
  • Inconsistent results derived from location-based searches; and
  • Listings of doctors who have retired or died.

Data on the Physician Compare site are derived from the Medicare Provider Enrollment, Chain and Ownership System, so information missing or incorrect on the PECOS file could transfer to the Physician Compare site, according to American Medical News.

AnnMargaret McCraw — CEO of Midlands Orthopaedics in South Carolina — said physicians not appearing correctly on the site are at a disadvantage because potential patients might not be able to find them.

Other physicians are concerned that if CMS cannot provide accurate biographical data, expanding the site with quality performance data might not provide patients with trustworthy information (Fiegl, American Medical News, 5/9).

For original article and to read more visit ihealthbeat.org

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Will Pending Government Shutdown Halt Medicare?

April 6, 2011 By Leave a Comment

The Medicare program would continue to be funded if the government shuts down later this week, but other Health and Human Services (HHS) programs would not, a senior administration official told reporters Wednesday.

With the latest short-term spending bill expiring April 8, administration officials are preparing for a federal government shutdown that now appears imminent. One official said President Barack Obama has made it clear that a shutdown would threaten the country’s economic recovery, but added, “From a good-housekeeping perspective, we’re cognizant that it’s Wednesday and that all agencies are prepared with contingency plans.”

That includes HHS, which has submitted its operations plan to the Office of Management and Budget. At deadline, an OMB representative was not available to answer questions about the plan’s details. One official cited HHS’ National Institutes of Health as a program that would be affected by the shutdown. Current clinical trials would continue to be funded, but new patients and new trials would not be accepted.

According to officials, government activities fall into two categories: those that have other funding sources, such as user fees or multi-year funding; and those that are necessary for the safety of life and property, such as the nation’s military and law-enforcement activities. Essential services that would be affected include the closing of national parks, the suspension of tax refunds for paper-filed returns, and federal loans for small businesses and homes.

Read more: Modern Healthcare

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Medicare Fraud: Not a Faceless Crime Any Longer

February 8, 2011 By Leave a Comment

(AP) WASHINGTON — Health care fraud once was a faceless crime. Now it has a mug shot, even a smile.

Medicare and Medicaid scams cost taxpayers more than $60 billion a year, but bank holdups are more likely to get greater attention.

The government wants the public’s help in trying to catch more than 170 fugitives wanted for fraud, so it’s developed a new health care most-wanted list, with its own website -http://www.oig.hhs.gov. Most are dour; some sport smiles.

One name on the list is Leonard Nwafor, convicted in Los Angeles of billing Medicare more than $1 million for motorized wheelchairs that people didn’t need. One person who got a wheelchair was a blind man who later testified he couldn’t see to operate it.

Facing time in federal prison, Nwafor disappeared before his sentencing.

“We’re looking for new ways to press the issue of catching fugitives,” said Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department. “If someone walks into a bank and steals $3,000 or $4,000, it would be all over the newspaper. These people manage to do it from a less high profile position, but they still have a tremendous impact.”

Even though motorized wheelchairs can cost up to $7,000 apiece, Nwafor’s scam was on the low end when compared with others who made the most-wanted list.

Sisters Clara and Caridad Guilarte allegedly submitted $9 million to Medicare in false and fraudulent claims for pricey infusion drugs that were never provided to patients. They are accused of offering cash and other rewards for beneficiaries to visit their clinic in Dearborn, Mich., and sign forms that said they received services that they never got.

An alleged accomplice was arrested in the Dominican Republic recently, but the sisters remain at large.
[Read more...]

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iPad used to check mobility (MAT) in Seniors

February 3, 2011 By Leave a Comment

WINSTON-SALEM, NC – Mobility is a “vital” sign that should be regularly checked in adults over the age of sixty, and according to two health and exercise science professors at Wake Forest University, the iPad is just the tool for the job.

Mobility is closely linked to overall health and quality of life, but healthcare professionals have not had an easy and effective way to assess it.

That’s why professors Tony Marsh and Jack Rejeski with the help of colleagues in the computer science department (Yue-Ling Wong) and Wake Forest University Baptist Medical Center (Eddie Ip), developed the Mobility Assessment Tool (MAT).

MAT, which was created for the iPad and PC, assesses mobility in older adults using video animation rather than written questions. The whole process takes about four minutes to complete. The score provides information that helps older adults better understand their current mobility and can provide a yardstick to monitor changes in how well they get around.

Using an iPad or PC, older adults watch short videos of animated figures performing everyday tasks such as climbing stairs or walking while carrying a bag of groceries. The videos help senior citizens picture themselves doing these tasks. They then use the touch screen to indicate what they can and cannot do.

“In pilot testing, we found that the animation technology allowed older adults to project themselves into the tasks,” Marsh says. “This removed potential biases that would have occurred if actual people had been filmed doing the tasks.”

Marsh and Rejeski say the MAT is a quick, simple and cost-effective way to accurately measure mobility and may help practitioners plan appropriate interventions to remediate limitations. They envision the elderly getting “activity prescriptions” to improve their physical function based on the results of the Mobility Assessment Test.

The MAT could also be administered in the waiting room before a patient talks to the physician, the professors say.

“This is a tool that could be used quickly in a physician’s office or out in the field,” says Rejeski, who has found the MAT to be useful in his research on older adults and mobility.

Using animation instead of actors makes the tool more adaptable and less expensive. Its touch screen technology also dramatically decreases the time of test taking. The benefits of the technology allows for greater flexibility in altering the form, speed and environmental parameters of mobility-related tasks, opening up a wide range of possibilities for future research questions, said Marsh and Rejeski.

The MAT will be used by researchers involved in the LIFE study, a major multi-year project funded by the National Institutes of Health that is designed to determine the effects of physical activity and successful aging interventions on major mobility disability. Recently Marsh and Rejeski have also been asked to collaborate in a cross-cultural study of mobility in older adults with researchers from Canada, Brazil and Columbia that will use the MAT.

by Molly Merrill, Associate Editor – HealthIT News

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