Is PACE the Answer to Scarcity of Geriatricians in the U.S.?


By Lisa Price, M.D.

The math is easy. The numbers of older adults in the United States continues to increase, while the number of physicians entering training programs for geriatric fellowships is decreasing.

Our traditional reimbursement model, which values procedures and acute care over management of multiple chronic conditions, is a major contributor to the decrease in new geriatricians.

The Numbers

In the U.S., 10,000 people turn 65 years old every day. In just 14 years, approximately 20% of the population will be 65 years or older; that’s 72 million people in the U.S. alone. The amount of 65-84 years old will reach approximately 63 million. Growing older also means an opportunity to accumulate a greater number of comorbidities, ranging from chronic arthritis and heart failure, to debilitating dementias.

By 2050, it’s estimated there will be 1.5 geriatricians for every 10,000 people 75 years old and older, a decrease of 3.2 geriatricians for every 10,000 people from 2000, according to the American Geriatrics Society.

The work of a geriatrician may not be considered exciting or glamorous, but it is important, invariably interesting, rewarding and cost-effective.

 

Geriatricians and the geriatric patient do not easily fit into our current healthcare system. In a productivity-based clinic environment, a new patients is expected to be seen every 15 minutes, however it can take 15 minutes to get an elderly patient back to the room, obtain vital signs and ready for an exam.

Geriatricians and the work they do may not fit in a value-based reimbursement model either.

Due to their advanced age and multiple co-morbidities, elderly patients do not easily fit into typical quality metrics for the management of many chronic conditions, including diabetes control and cancer screening.  Geriatric care is at its core comprehensive, patient-centered and coordinated care—it is time-consuming and intensive and is not likely be replicated by telephonic case management.

For all the challenges in real-life and the high jinx on television—like the HBO show “Getting On”—there are success stories, for the geriatrician and older patients, in the real world.

One such success is the Program of All-inclusive Care for the Elderly (PACE).

PACE yourself

PACE is a great answer for those geriatricians committed to their craft and their patients.

A Medicare and Medicaid care model designed to improve care coordination and outcomes for underserved older adults, PACE takes place in a single facility housing medical, dental, occupational and rehabilitation therapy, adult day, pharmacy and more. The care coordination afforded participants typically leads to improved outcomes for participants.

PACE is an interdisciplinary team model where the patient, the care delivery system and the payment system are aligned. The primary care physician and the interdisciplinary team have the opportunity to make a positive impact on the lives of many older adults while not having to worry about the many reimbursement issues.

As PACE programs expand nationwide, more opportunities for board-certified geriatricians and primary-care physicians with interest and expertise in caring for seniors become available. Primary care delivery in PACE programs varies from employed physicians to contracted providers. Some programs may use a physician or a nurse practitioner to provide care. In general, PACE work is full-time employment, so physicians must have a passion for the work.

Can PACE be the answer to the scarce lack of geriatricians in the U.S.?
PACE participants enjoy a football party.

In addition, PACE programs benefit geriatricians because it is not a production-based model so it allows the physicians to spend time with each participant without needing to worry about pushing the patient through the system quickly. Collaborating with the interdisciplinary team allows for greater support and more comprehensive care, as well.

For geriatricians, this creates an atmosphere conducive to spending the necessary amount of time with patients. While there’s no single answer to handle the coming influx of older adults and falling numbers of geriatricians, PACE can be a refuge for those physicians looking to continue providing hands-on, high-quality care to older adults.

Lisa PriceLisa Price, MD is chief medical officer at Denver-based InnovAge, a provider of health and wellness services for older adults in California, Colorado and New Mexico. Price was a private practice geriatrician for 11 years, and then attended on the Acute Care of the Elderly (ACE) service and taught quality improvement at the University of Colorado. She is board certified in internal medicine and geriatrics, and has expertise in managed care, electronic health records and quality improvement. http://MyInnovAge.org.

This article originally appeared in Medical Economics.

 

 

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