Eric C. Rackow, M.D.
The widespread concern among senior citizens about controlling the cost of health care is well founded. The discussion about cost control often centers on controlling the growing cost of Medicare. However, our seniors are worried that cost control means less health benefits for them as the means by which overall health care cost will be contained. Seniors know that as they grow older they need more, not less health care. In an age of unprecedented advances in medicine, our country is growing older. And the older we get, the more we develop disabilities and chronic health conditions. In addition, baby boomers will start to enter the ranks of Medicare beneficiaries in 2011 and will almost double the number of citizens who are 65 years or older over the next two decades.
Maintaining the quality of health care for seniors while at the same time controlling costs must be part of any successful health care reform program. The single most important issue that helps solve this conundrum is the quality and effectiveness of caring for people with chronic illness. Four out of every five Medicare beneficiaries have a chronic illness. Medicare spends two-thirds of its budget on beneficiaries who have five or more chronic illnesses. A substantial portion of this spending is related to frequent hospitalization. Although older adults over the age of 65 years comprise 12 of the United States population, they account for 38% of all hospital admissions and 44% of the national hospital bill, approximately $350 billion per year. Without a clear path too improving the treatment of chronic diseases, these costs will continue to increase.
Since hospitalization is the most costly part of caring for people with chronic illness, the single most important way to control these costs is to avoid hospitalization. The solution is better coordination and provision of care outside of the hospital. For example, currently 20% of Medicare beneficiaries are re-hospitalized within 30 days of discharge from the hospital. It has been demonstrated that coordination of care by advanced practice nurses when elderly patients transition from the hospital to home can reduce re-hospitalizations. For example, the rate of re-hospitalization for SeniorBridge patients with care management is only 8.5%.
There is also compelling evidence that long-term coordination of care at home for people with chronic illness is effective. Licensed nurses and social workers who “manage” care at home can improve the quality of treatment, avoid costly hospitalizations, and allow seniors to remain safely at home. Care management for the chronically ill must be part of health care reform.
Eric,
The Social Workers and Discharge Planners at the hospitals I work with agree, re-hospitalization is one of the biggest concerns they have.
Has there been any thoughts about involving Geriatric Nurse Practitioners in the care of your patient population?
These advanced practice nurses are master’s prepared and have a thorough working knowledge of functional assessments, advance direcitve planning and are able to care for patients with more chronic, complex disease states.
Furthermore, they are able to provide a medical model of care and with the current environment in healthcare, everyone is looking for ways to decrease medicaire waste and improve overall care in the home and out of the hospital setting where so many interventions cause a rapid decline in our elderly population.
I am hopeful that the future of healthcare reform will see the enormous benefit of using Nurse Pracitioners and the value and savings they can bring to all patients and families.
Sincerely,
Mary Pizzingrillo ANP-BC
Without a doubt, the utilization of advanced practice nursing will be essential if we are to successfully manage people with complex chronic care needs and severe functional deficits. As it now stands, these individuals are care for with costly multiple hospital admissions and long-term institutionalization. Medical education has failed to produce primary practioners and geriatricians. Geriatric Nurse Practitioners are the obvious solution to the enormous health care problems we are facing as the baby boomers age. We at SeniorBridge anticipate the integration of a physician directed nurse practitioner program in the near future.
Our economy is threatened by our growing health care bills. We can’t afford to do nothing.
It is good to finally see this congress pass a monumental health care bill that will become law in the coming days. Great time for our country.
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