After much study, it should not be surprising that the best way to manage ill seniors, is by communication – between patients, nurses and doctors. This communication essentially continues and reinforces the flow of information that patients need to help maintain effective care regimens. This is particularly true when the patient is older and may have multiple medical conditions, medications and health care providers. The models needed are not costly, bureaucratic, government driven programs to oversee this, but fundamental models of e-communication and voice communication, backed up by regular face to face interactions. In summary, traditional good patient care and followup. But this model requires that we have enough doctors and nurses to interact and both disciplines are stretched thin. It also will require a more robust integration of e-communication tools to allow patients tele-access to their care providers, thus reducing the need for excessive travel, which is often a physical and financial burden for the ill elderly. That is the best medicine for the economic concerns addressed in these articles and the simpler the system created the better and more useful it will be . . . jomaxx
Programs to coordinate care for chronically ill Medicare patients may not reduce hospitalizations, cut costs, researchers say.
An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn’t work, according to a study published in the Journal of the American Medical Association. These results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many different doctors and sometimes get conflicting medical advice.
Mathematica Policy Research Inc. in Princeton designed the “pilot project.” In their analysis, Mathematica looked at 15 care-coordination programs involving more than 18,000 fee-for-service Medicare patients with chronic problems such as congestive heart failure, coronary artery disease and diabetes. Only two programs were successful, and both had certain features in common, namely more contact between nurse-coordinators and patients and more contact between coordinators and physicians. The studies lead author said that both these programs had good relationships with local hospitals and with patients’ physicians.
For two programs — Mercy Medical Center in Des Moines, Iowa, and healthcare provider Health Quality Partners in Doylestown, Pa., — the treatment group did have lower expenditures than the control group, but the differences were not statistically significant, the researchers said. Those findings suggest that the potential exists for care coordination interventions to be cost-neutral and to improve patients’ well-being, according to the researchers.
Sobering results for cost-cutting Medicare project @ http://archives.chicagotribune.com/2009/feb/10/health/chi-ap-med-medicaredisappoi
Medicare Faces Challenges Caring for Chronically Ill @ http://www.healthday.com/Article.asp?AID=623921
Care Coordination Programs Do Not Meet Goals @ http://www.medpagetoday.com/Geriatrics/Medicare/12834
http://jama.ama-assn.org/cgi/content/full/301/6/603
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I agree! There is no substitute for well-trained good doctors and nurses. The problem is: no one wants to pay for doctors anymore. For example, maternity coverage (delivery is the most common reason for hospitalization in the United States) is excluded from many insurance plans. A staff obstetric nurse earns more per hour than a certified nurse midwife and an ob physician (at least in my area). People are not going to provide demanding care for free. Medicare and Medicaid do not pay physicians enough to cover expenses of running a medical practice, and that defect is unlikely to be solved merely by implementing “universal coverage.”
Compensation is clearly a major issue. No person is going to submit to the rigors of training to become a physician or nurse if there is insufficient and inadequate compensation. There is no question that health insurance expansion will INCREASE the burdens and demands upon the medical system and providers. Demands which are going to, by their very nature, increase costs. This is one of the key themes we have been commenting on, the dishonest representation by politicians regarding health care related costs. Expansion of coverage will not save money, it will cost money. That is not in any way a comment against coverage expansion, as we have outlined in our plan on this site, but a statement of economic reality. Your comment about maternity coverage is just another example of blatant discriminatory practices on the part of health insurers (more on that later). We will be commenting more on the cost/compensation issues in weeks to come. Thanks for the great comment and thoughtful post! Please keep them coming!
I agree there is no substitute for a strong clinical team. I also think e-communications has benefits, but it also has risks. Risks to the patient, caregiver and clinical team. It will be a good day when these risks can be mitagated so the opportunities can be realized.
Jim, the risks can be mitigated upfront in many cases. No provider should fear e-medicine or e-communication due to risks (usually sited as HIPPA related, medico-legal and now the FCC Red Flag issue). We have NEVER believed that providers should be timid or fearful. Physicians and all health care providers must be first and foremost patient advocates. There a many issues related to this, of course. However, the integration of HIT, properly done, will benefit all parties. We have commented on the potential abuse of HIT and e-medicine by those who seek control of the health system and choices provided to patients and providers. We will continue to tirelessly voice opposition to those efforts. In the end, your comments are on target. Thanks for the comment and keep them coming!
The reason no one wants to pay for a “real” –-evidence-based; compassionate; experienced –– nurse or doctor is because the only thing anyone talks about is immediate cost. No consideration of avoided cost or quantified long term benefits. In other words, there is only immediate outlay and no cost/benefit analysis.
Repairing a child with transposition of the great arteries “costs” over $100,000. Kidney dialysis costs over $100,000 per year. Heart transplant is $250,000 for initial procedure. Why would anyone pay for these? Ignoring the humanitarian reasons, you do it because NET long term, the cost/benefit analysis would show a positive outcome: nobody does this calculation.
Deane, great points. The truth is the “system” (i.e. government and payers) never consider long-term benefits of any decision. Long term for them is basically a business quarter or at best a fiscal year. Beyond that, we are all on our own. Cost/benefit analysis is very much the correct way to view health care spending. Have you ever wondered why health care spending is a “cost” as opposed to an “investment”? Many other essential spending items are considered investments in infrastructure, technology, education and the like. How is that we do not consider health care spending an investment in our citizens? Health care “spending” creates millions of jobs in clinical care, research, pharmaceuticals, devices, basic science and many related fields. These are not costs, they are investments and economic engines. Until we begin to re-think our views on what is really cost and what is really investment, most discussions will focus on short term, bottom line objectives. Thanks for the comment. Keep them coming!