The Age-Friendly Hospital Rating is a new structural measure included in the Centers for Medicare & Medicaid Services (CMS) 2025 Inpatient Prospective Payment System (IPPS) Final Rule.
This measure is designed to assess hospitals’ commitment to delivering high-quality care to patients 65 and older. The rating focuses on five key domains: patient goals, medication management, frailty screening, social vulnerability, and leadership commitment.
Hospitals must affirmatively attest to these domains to demonstrate their compliance with best practices for older adults. The implementation of this measure includes specific data collection and submission requirements, as outlined by CMS.
Under the 2025 IPPS Final Rule, hospitals and health systems are required to submit data for the Age-Friendly Hospital Rating measure on an annual basis. The data submission is structured around the five domains, and hospitals must evaluate whether they meet the criteria for each domain fully to receive credit.
Partial compliance with a domain does not earn points, meaning hospitals must engage with all the elements within a domain to receive one point for that area. For example, in the domain focused on frailty screening and intervention, a hospital must meet all corresponding attestation statements to earn a point. This includes a requirement to screen for risks of malnutrition, mobility, and mentation, upon admission or before major surgery. Qualifying plans must submit management plans, and data collection is required.
This measure also requires processes to lower the risk of delirium in the emergency room.
The data collection process is streamlined through the CMS Hospital Quality Reporting (HQR) system. Hospitals will use this tool to submit their data once per year. The CMS tool will collect the hospitals’ attestation statements for each of the five domains, verifying whether they can affirmatively attest to engaging in the best practices defined by CMS for the care of older adults.
Additionally, the IPPS Final Rule mandates that hospitals report their measure results, regardless of their responses to the attestation questions. This reporting is part of the pay-for-reporting structure of the Hospital Inpatient Quality Reporting (IQR) Program, which ensures that hospitals provide transparent data about their care practices for older adults.
Hospitals are not penalized financially for their attestation responses, but are required to submit accurate and timely data through the HQR system.
Hospitals must submit this information annually, with mandatory reporting beginning in the 2025 reporting period. The Age-Friendly Hospital measure aims to ensure transparency and consistency in hospital reporting, allowing CMS to monitor and improve the quality of care delivered to older adults across the healthcare system.
Although many of the measures in this initiative overlap with other quality reporting requirements, it may be beneficial to review and ensure there is a crosswalk with the initial nursing documentation, therapy evaluations (PT, OT, and ST), and case management/social work documentation to ensure that information is easy to extract for data collection, reporting, and future interventions.
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