Frequently Asked Questions about the Geriatric Surgery Verification Program

• If your hospital has fully implemented and streamlined all 30 GSV Program standards, apply for GSV Focused Excellence or GSV Comprehensive Excellence Verification.
• If your hospital is just getting started with age-friendly initiatives or still working on implementation and process changes, specifically within the EMR, we recommend applying for the GSV (Age-Friendly) Level.

Yes, each hospital will need to apply separately, as enrollment through the application process is at the hospital-level.

The annual fee covers all program services, including access to the ACS Quality Portal (QPort) and all its resources, including the GSV Implementation Course, attendance to GSV webinars and teaching sessions, access to staff for support purposes, and all verification-related program components, including the Pre-Review Questionnaire (PRQ), site visit, and annual attestations

• The GSV (Age-Friendly) Level is applicable to patients 65 years and older who are having inpatient surgery.
• The GSV Focused Excellence and Comprehensive Excellence Levels are applicable to patients 75 years of age and older who are having inpatient surgery.

In-patient is defined as operations that are expected to need 2 or more midnights of medically necessary hospital care.

The GSV Levels are designed to be a stepwise approach; once verified at the GSV (Age-Friendly) Level, it is up to the hospital’s discretion to determine when the appropriate time is to move forward with the full program (Focused Excellence or Comprehensive Excellence). This will vary across hospitals depending on hospital resources and implementation strategies.

Yes, there are several resources available on the GSV Website, within the ACS Quality Portal (QPort), and within the GSV Implementation Course. Please contact the GSV Team at geriatricsurgery@facs.org or refer to the GSV Resources webpage located here for more information

Visit our CMS Age Friendly Hospital Measure page to access resources and frequently asked questions about the measure and how ACS GSV can help your hospital meet the requirement.

Commitment Level hospitals can reapply for a Verification Level as soon as their GSV leadership team feels they can demonstrate consistent implementation of all standards in those specialties enrolled in the program. This typically occurs within 2 years. Commitment Level hospitals are expected to be actively preparing for verification during their enrollment for a maximum of 2 years. The GSV Commitment Level hospitals will receive formal recognition of their commitment to high-quality geriatric surgical care.

Yes, a hospital can participate in the GSV Program without participating in NSQIP, but GSV hospitals that are also enrolled in NSQIP have the option to collect additional variables for patients 75 years and older at the time of surgery.

At this time, the GSV Program is available only to hospitals within the United States and Canada.

Hospitals receive access to the PRQ once a contract has been signed and payment has been remitted

The GSV Implementation Course is a benefit of joining the GSV Program. Hospitals will receive access to the course once a contract has been signed and payment has been remitted.

The Centers for Medicare & Medicaid Services (CMS) released a new Age Friendly Hospital Measure on August 1 designed to improve the care of older adult patients that is substantially based on the ACS GSV Program. It is intended to help hospitals provide high-quality, patient-centered care for older adults by driving improvement across five domains.

All hospitals that participate in CMS’s Hospital Inpatient Quality Reporting Program (IQR) are required to comply with this new measure beginning January 1, 2025, and report it to CMS each year. Compliance with the measure will be reported on the CMS Care Compare website allowing patients and caregivers to know which hospitals deliver age-friendly care for seniors.

The ACS led the development of the measure in collaboration with the Institute for Healthcare Improvement (IHI) and the American College of Emergency Physicians (ACEP), with support from The John A. Hartford Foundation. This measure focuses on improving the care delivered to the growing population of older adults.

The CMS Age Friendly Hospital Measure will evaluate hospitals’ progress toward improving care for patients aged 65 and above across various settings, including hospital wards, operating rooms, and emergency departments. The measure is structured into five domains:

1. Eliciting Patient Healthcare Goals: Ensures patient health-related goals and treatment preferences are obtained to inform shared decision-making.
2. Responsible Medication Management: Optimizes medication management by monitoring pharmacological records to avoid inappropriate drugs for older adults.
3. Frailty Screening and Intervention: Screens for cognitive impairment (including delirium), mobility, and malnutrition, allowing for early detection and intervention.
4. Social Vulnerability: Recognizes and addresses social issues impacting older adults as part of the care plan such as social isolation, economic insecurity, ageism, caregiver stress, limited access to healthcare, and elder abuse.
5. Age-Friendly Care Leadership: Identifies an age-friendly champion or committee in the hospital to ensure compliance with all components of the measure.

Hospitals will have to report whether or not they are complying with the measures included in the five domains. Because the Hospital IQR Program is a pay-for-reporting program, hospitals would receive credit for the reporting of their measure results regardless of their responses to the attestation questions.

Hospitals need to comply with the measure beginning January 1, 2025, for the entirety of the 2025 reporting year, which ends on December 31, 2025. Hospitals would then submit attestations for the domains they were compliant with from April 1, 2026, to May 15, 2026.

Hospitals participating in the Inpatient Quality Reporting (IQR) Program that fail to comply could face significant financial penalties. In addition, the public will be able to see what hospitals fail to comply on the CMS Care Compare website in 2026.

The ACS GSV Geriatric Surgery Verification (GSV) Program is specifically designed to address the five domains included in the measure. This new level draws from the detailed GSV Optimal Resources for Geriatric Surgery standards, which were launched in 2019 to meet the specific surgical needs of older adult patients.

The ACS GSV program is grounded in evidence and provides hospitals with strategies to decrease postoperative delirium-related complications, reduce readmissions costs, and enhance patient quality of life. Using GSV, a hospital can reduce the average length of stay—generating significant cost savings and increased patient satisfaction.

Yes, a study by Katlic and colleagues published in Annals of Surgery Open, demonstrated that several hospitals have seen a decreased length of stay of 1–3 days by implementing the GSV program or similar programs. In addition, the study indicates that the GSV program helps hospitals prevent cases of postoperative delirium resulting in significant savings. Each episode of postoperative delirium will cost a hospital an average of $20,327 per admission.

The Katlic study enumerates many additional benefits of the GSV Program that more than offset the annual fee required to participate in the program.

*Katlic MR, Wolf J, Demos SJ, Rosenthal RA. Making a Financial Case for the Geriatric Surgery Verification Program. Ann Surg Open. 2024;5(2):e439. Published 2024 May 13. doi:10.1097/AS9.0000000000000439