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Senior Care Requires a Different Approach

old-man-and-nurseWhen working with older patients, hospitals and physicians often find themselves between a rock and a hard place — struggling to find a balance among efficiencies, cost containment, reimbursement requirements and the finer points that actually impact patient satisfaction. Are these mutually exclusive? Not necessarily, as a recent Health Affairs article suggests, if healthcare providers change their approach to caring for the elderly. And change is definitely needed. After all, 3 million Baby Boomers will hit retirement age — and Medicare eligibility — every year for nearly two more decades.

Hospitals must make progress towards providing value while improving patient outcomes to stay competitive in a reformed U.S. health system.

Older Patients Need a New Approach

The Health Affairs article suggests that healthcare providers sometimes suffer from not being able to see the forest for the trees — focusing on medical care at the expense of older adults’ well-being. Author Louise Aronson, associate professor of medicine at the University of California, San Francisco (UCSF) and director of the Northern California Geriatrics Education Center, cites her own experience after a chance meeting with an elderly patient.

What started out as concern for a woman who was abandoned by two different cab drivers turned into a quest to find a better way to help her manage her healthcare journey. As Aronson notes, “It didn’t take a rocket scientist — or even a geriatrician — to figure out why taxis didn’t want to pick up Eva. Doctors and medical practices often invoke the same reasoning: The old move too slowly, making efficiency impossible. And more often than not, there are complications.”

After receiving permission from the elderly woman to look into her medical record, Aronson discovered just how dysfunctional traditional healthcare is when it comes to treating older patients. The clinicians themselves were providing excellent care within their areas of specialty. Aronson said her doctors and nurses clearly knew their patient and were “… applying all of their considerable expertise on her behalf.” She continued, “Unfortunately, their expertise didn’t include any of the skills that would have addressed the patient’s most pressing needs.”

What she didn’t see in the medical notes were indications that providers had tried to connect the patient with social services or better care coordination to alleviate fragmented, burdensome care and make life easier for her. The patient’s own priorities and personal care goals were not captured or reflected, representing a clear miss for effective geriatric care.

In the end, Aronson helped this octogenarian with more than a ride home. She helped connect her with a geriatrics practice with a team — geriatrician, nurse, physical therapist and social worker — to help the patient manage her chronic conditions better. And, ultimately, the more hands-on approach reduced both the patient’s cost of care and transportation. With the money saved, she was able to engage home care assistance that allowed her to continue to live independently.

The Correlation Between Improving Patient Outcomes and Costs

One of the keys to success in the Health Affairs story was the fact that the geriatrics practice focused on the patient’s goals. By understanding the personal goals and expectations of healthcare consumers, hospitals and other healthcare providers can communicate more effectively to drive patient engagement. And a more motivated patient is more likely to follow prescription regimens and other care directives, and that, in turn, will lead to lower costs of care. 

This is crucial as hospitals and other healthcare providers look to an uncertain future when it comes to Medicare risk-adjustment scoring and payment rates. While the latest news from the CMS seems to indicate a slight increase in the rate for 2016, the new risk scoring system could negatively impact payments for the sickest seniors according to a report by the health insurance industry lobbyist America’s Health Insurance Plans.

With one-third of all Medicare beneficiaries on Medicare Advantage plans — and that number increasing by 8 percent a year — hospitals and healthcare providers must make meaningful connections with older Americans managing chronic health conditions.

Bette Davis once said, “Old age ain’t no place for sissies.” In an era of healthcare reform, improving patient outcomes while managing reimbursement concerns for elderly patients isn’t for the faint of heart either.

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