Pawlson (1993) has identified 10 reimbursements that adversely affect the supply of physician services for older people. Among the approaches that he suggests can be used to improve the situation are creating modifiers that denote patients with multiple functional impairments, expanding the number of payment codes for evaluation and management services and further increasing the assigned value for these services, creating a set of payment codes for comprehensive geriatric assessment, and developing Medicare Part B reimbursement for graduate medical education or allowing the time spent by residents in home care, office, and nursing home settings to be reimbursed by Medicare Part A graduate medical education funds.


The Alliance for Aging Research is engaged in the development of leadership centers in geriatrics established through one-time $1.5 million grants (one grant per institution) from a corporate or other private sponsor. They also propose the creation of a National Geriatrics Development Fund to be cosponsored by multiple foundations and individual donors to augment the initial grant to each leadership center. The alliance envisions as many as 10–15 leadership centers in geriatrics at U.S. medical schools (Alliance for Aging Research, 1993).


ADGAP has developed a proposal, “Geriatrics in the Next Decade: a Blueprint for Change” (David Lipshitz, ADGAP, personal communication, 1993). The document outlines a number of specific strategies for addressing the work force shortage in geriatrics, the lack of leaders in geriatric medicine, and the lack of support for training in geriatrics medicine by administrative heads of academic programs. Among the strategies proposed are (1) higher salaries for trainees and geriatric fellows, (2) low-interest loans for the development of academic careers in geriatric medicine, (3) a loan forgiveness program for physicians entering training in geriatrics medicine programs, (4) improved reimbursement for interdisciplinary care of geriatric patients, (5) training programs that are aimed at amplifying and fostering the research skills of geriatrics fellows, (6) increased funding for Claude D. Pepper Older Americans Independence Centers and Geriatric Academic Programs, and (7) creation of a 4-year dual certification program that would combine 2 years of training in general medicine and 2 years of training in geriatrics medicine. The report also recommended the development

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