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Starting the Dialogue with your Aging Parents: Fielding the Trends

March 3, 2014

As health care consumers many patients are unaware of the changing trends in healthcare. I’m not talking about the Affordable Care Act and all of its requirements. I’m not talking about new treatments for chronic diseases or the discovery of new pathogens. My post today will address one of the intricacies of reimbursement and how it is changing the landscape in the management of acute illness and, most especially, in chronic disease management.

You may be asking how this has anything to do with you starting a dialogue with your aging parents?

Hang with me for a few minutes and I’ll try to explain because you can play a very important role in helping your parents navigate through these particular changes as they start to unfold rather than later.

First let’s review some economics that have to do with health care.

  • Many private practice physicians, clinics of all sizes, and hospitals of all sizes depend on Medicare and Medicaid reimbursement in order to stay afloat. Medicare is a federal program and Medicaid is overseen by the states. I’m going to make a broad generalization here but usually if Medicare sets out a ruling Medicaid attempts to fall in line. Physicians, clinics, and hospitals have t o “opt in” to accept Medicare and Medicaid assignment of the benefits allowable and they cannot charge the patient for charges above what the Medi/Medi (Medicare and Medicaid) plans will pay.
  • Private insurance usually reimburses at a higher rate than Medi/Medi. Once again, if the physician, clinic, or hospital is a participating provider with a private insurance plan, HMO, PPO, or MCO they agree to accept what the plan allows as reimbursement for services rendered. Patients may be responsible for part of the allowable charges.
  • Since Medi/Medi and private insurance plans are the primary sources of reimbursement for most health care entities they lay out some very strict guidelines and highly regulate the health care business. In addition, they also have very large and “loud” lobbying abilities when it comes to legislation related to health care.
  • Please keep in mind this important factor related to the economics of health care: people are getting older and with aging they are getting sicker. That means treating those who are getting sicker is becoming more expensive because the cohort of aging seniors is growing as the baby boomers move into their later years. This means there is the possibility of health care costs outspending the funds available.

I hope you’re still with me on this because now we move into what may develop as a way to cut costs.

There is a new trend to focus on “Patient Centered Medical Homes” as a way to shift some of the burden away from the medical providers and onto the patients. The concept is a good one and actually very empowering for the patient, but it is often misunderstood and resisted by both health care providers and patients.

Bear with me as I attempt to explain.

  • For years patients have turned over total control of their health to their health care providers. If the doctor says take this medication for your high blood pressure or your cholesterol then most patients will do it without worrying or even thinking twice. If a physician recommends a colonoscopy every ten years after the age of 50 many patients will simply comply and get it done when they are reminded to do so.
  • Many patients I see every day have decided that they don’t need to worry about what they eat or how much physical activity they engage in because if their symptoms get worse they can always get another pill, have a surgery, or get a treatment to take care of it. The same goes for smoking or substance abuse (alcohol and drugs).
  • An idea that we are entitled to excellent health care without responsibility for our own individual health has become rampant and is especially prominent in the elderly at this point. I’ve had more than a few patients say something along the lines of “I worked hard all my life, paid my taxes, and now Medicare will take care of me when I’m sick.” Some go even further to say… ” if Medicare doesn’t cover it then Medicaid will take over and I’ll be fine.”

All three of the bullet points directly above are a very dangerous way to think in this age of changing health care trends and exorbitant costs. I hope I’ve grabbed your attention and that you are starting to think on these points. Don’t take my word for it, read the newspapers and journal articles. Listen to the debates about health care. One thing crops up over and over again–we need to cut the costs of health care.

Ok, now back to the “Patient Centered Medical Home” concept. This idea (for which many doctors, clinics, and hospitals are seeking recognition) means exactly what it states: the patient is at the center of their own health care.  For years we’ve had patient rights about privacy and choice. Now the idea is to get the patient actively engaged in their health care as truly equal partners.

For instance, someone comes in with a new diagnosis of diabetes. Instead of the doctor laying out the entire treatment plan  and telling the patient what medications to take and what needs to change the doctor will discuss evidence based guidelines for treatment and emphasize that the patient’s own involvement will dictate the course of treatment.

From there, the Medi/Medi and private insurance plans will be looking to see where the greatest outcomes are and they will reimburse for services based on the measurable outcomes such as lab work, hospitalizations, length of stay in the hospital, use of the emergency rooms, weight loss, and other measurable aspects of healthier lifestyles.  Where they see the greatest impact and care provided to increase the populations health will be where the greater reimbursement goes. In offices, clinics, or hospitals where the chronic disease rates don’t change and people aren’t taking better control of their individual health the reimbursements will be less.

What does this mean?

  • Eventually fewer doctors will think favorably of practicing in an area where there are lower reimbursements. This means that patients may not have access to convenient or local health care.
  • Maybe doctors won’t accept patients who are not willing to work diligently to improve their health care.
  • The sickest individuals may find themselves not receiving the same level of care that they expect.

Please note that the above three bullet points are not set in stone or even policy, but could become so in the future.

What can you do now to avoid any negative effects for your aging parents, yourself, and your children?

  • Start the dialogue about healthy lifestyle adjustments. This can be about the food that is eaten, physical activity, decreasing  and then stopping unhealthy behaviors,  and speaking up about what care is desired and actively stating wishes about treatment.
  • Encourage a healthy diet that is based on lean protein, whole grains, at least the minimum servings of fruit and vegetables, and low-fat dairy. Avoid processed food and calories with no nutritional value.
  • Make sure you, your parents, and your children are adequately hydrated with water. The amount varies with each individual but paying attention to whether  skin is dry or supple is a good simple indication of hydration status. If skin is dry then drink more fluids.  If it is smooth and supple then hydration is probably adequate. There are other ways to test hydration status and you can ask me a question in the comments section if you want further clarification.
  • Physical activity is  a great way to improve mood, avoid putting on the pounds, and keep circulation flowing. Look through the archives of older posts for more on this subject.
  • We all know smoking is unhealthy and excessive alcohol can lead to horrible disease problems. If your parents engage in either of these activities raise the subject gently, but let them know you are concerned for their health.
  • Encourage the development of health care proxies, living wills, durable power of attorney for health care documents, and end of life planning.
  • Help your aging parents understand that the medical providers they see want them to be involved and knowledgeable about their health and the care they desire. Assist your parents in researching any new diagnosis they may be given by a medical provider. Work with your parents to develop their concept of how they would like to see their care unfold and what actions they are willing, or not willing, to engage in to increase their health status. Most importantly, help them to understand that asking questions or stating their needs is expected by their health care providers and the best way for them to assist in getting the care they need and desire.

There is much more that could be said on this subject. Please feel free to leave comments or ask questions if you want greater elaboration. Thanks for reading my blog.

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