Guest Columns

Celebrating 40 years of AMDA

Christopher Laxton, executive director, American Medical Directors Association
Christopher Laxton, executive director, American Medical Directors Association

AMDA – The Society for Post-Acute and Long-Term Care Medicine held its 40th Annual Conference March 16-19 in Phoenix, AZ. It's amazing to reflect on, not only how much the Society has changed over the past 40 years, but also how much the post-acute and long-term care setting has changed – and I expect it will continue to evolve rapidly over the next 40 years.

Even since I joined the Society as Executive Director four years ago, I have seen the Society and the setting change a great deal. We've opened membership to include full voting rights for attending physicians, nurse practitioners, and physician assistants. Advocacy and dealing with new, complex payment mechanisms have become a bigger and bigger priority for our members. And the patients our members care for have shifted from the traditional long-term care nursing home patients, to a combination of those patients, post-acute care patients, rehab patients, younger adults, and those living in assisted living and community-based settings. Coming out of our Annual Conference, and carrying through the next few years, these changes, challenges, and opportunities have come into focus as five key priorities for the Society.

  1. Post-acute and long-term care should be recognized as a specialized area of practice.  

    This past fall, the Society's affiliate, the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) disseminated two job task analysis surveys – one for medical directors and one for attending physicians. Despite being comprehensive and pretty time-consuming, the surveys drew a strong response, and the results are now being used to define PA/LTC as a specialty field, and to outline the roles and responsibilities of medical directors and attending physicians in the current state of PA/LTC practice. Look for a full report in an upcoming issue of JAMDA. The analysis of the surveys will be used to focus education specifically for attending physicians and medical directors in PA/LTC and to show the value these practitioners bring in promoting quality, lowering costs, and improving transitions of care, communication, and patient satisfaction.

  2. PA/LTC practitioners need specialized education and training.

    An important educational priority already underway is the dissemination of our Competencies Curriculum. Part of our effort to educate practitioners who may be new to the setting, and to increase the consistency and quality of care provided by those who currently practice in the setting, the Society has defined competencies for the practice of PA/LTC medicine. Many national organizations signed on to support these competencies, including AAFP, ACHA, ASCP, LeadingAge, NADONA, SHM, and others. We have developed an online educational Competencies Curriculum to support these competencies and to provide education on the cornerstones of knowledge needed to practice in PA/LTC. The Curriculum was recently completed, and we will be looking to form partnerships over the year to circulate this important education.

  3. The PA/LTC practice setting requires appropriate quality measures.

    A key policy priority for us is to develop meaningful physician-based quality measures for the care of the PA/LTC population. One of the most frequent complaints I hear from our members is that the regulations they face, and the quality measures they must work with, provide disincentives to practice, which is simply unfair to them and to the patients they care for. Our practitioners treat the sickest, most vulnerable – and most costly – people in our US health care system. Many of these patients are reaching the end of their lives, have multiple comorbid health conditions, and face other social and personal challenges. A PA/LTC practitioner's quality of care can't be fairly measured when they are being compared to a healthy adult, or even geriatric, patient population. Two years ago, the Society formed a quality measures committee with the priority of identifying and developing clinically appropriate measures for PA/LTC. The committee is looking at many different ways to better define PA/LTC quality, such as developing new quality measures, tweaking facility-based measures, and finding funding opportunities for measure development. We strongly urge the Centers for Medicare & Medicaid Services (CMS) to provide flexibility in the program and to allow eligible clinicians to pick quality measures appropriate to their practice and to their patients, rather than picking measures simply to meet a compliance or reimbursement requirement.

  4. The Society's focus needs to cover all PA/LTC practitioners.

    Closely connected with our policy priorities is the creation of a new section within the Society. A large shift in the PA/LTC continuum is the increasing number of physician-led practice groups that are staffing and managing PA/LTC facilities. In response to this, at our Annual Conference I was proud to announce the launch of a new Practice Management Section.

    In forming this new Section, the Society is partnering with the Vision Group, a coalition of PA/LTC physician practices, which will focus heavily on the new payment mechanisms under MACRA, appropriate reimbursement specific to PA/LTC settings, and more. We also are excited to assist those in practice groups who may be new to our setting and may not have the same experience and education in caring for the frail, clinically complex patients in PA/LTC. We know that there is power in numbers and the addition of this section will increase the number of practitioners that we represent, and allow us to increase our influence both on Capitol Hill and in the federal agencies that regulate PA/LTC.

    5. Advancing these priorities will require new funding to succeed.

    Of course, with all of these initiatives comes the need for funding. Responding to this need, the Society's other affiliate, The Foundation for Post-Acute and Long-Term Care Medicine, has been shifting its focus over the past few years to serve as the main fundraising arm for the Society's many strategic initiatives. The Foundation will continue its work to strengthen the PA/LTC workforce through the Futures Program and to recognize exemplary professionals and organizations through Excellence and Quality Improvement Awards, while seeking funding from individuals, grants, corporations, state chapters, and nursing home chains to advance the Society's key strategic priorities.

You'll notice that each of our priorities has a common end goal – to improve the quality of care provided to the PA/LTC population. We do this by advocating for practitioners and patients, communicating and defining the importance of PA/LTC, and the difference that well-qualified and engaged practitioners can make within the setting, educating the workforce, and collaborating with the many important organizations and stakeholders in aging services, to ensure that quality care is provided to our nation's elders. I encourage you to contact me with your thoughts or ideas on how we may be able to collaborate and push these initiatives forward for the good of our colleagues in the field, and the families, patients and residents who rely on PA/LTC for their care and quality of life.

Chris Laxton is the executive director at AMDA – The Society for Post-Acute and Long-Term Care Medicine.

Guest Columns

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