Medicare spending is moving toward a plethora of higher reimbursement for in-office procedures and tests and away from what is most important and cost-effective for the health of older adults: good geriatric care.
I recently attended Academy Health’s annual research meeting in Chicago where the nation’s top health services researchers presented findings that directly relate to health reform efforts. The session, “Investigating the Causes of Medicare Spending Growth,” confirmed through Medicare expenditure analysis what those in the field of geriatrics suspected.
Bob Berenson, MD—a health policy expert newly appointed to MedPAC—showed that 10% of the reimbursement codes are responsible for 91% of Medicare spending. The top areas of disproportionate Medicare spending included tests and minor in-office procedures such as polysomnography for sleep apnea, Mohs surgery for suspected skin cancers, spinal injection for back pain, cardiac stress tests, and various scans of the brain and lumbar spine.
Why is Medicare spending rising? Is it the demographic shift or a change in health status? You won’t be surprised by the answer. Physician-created demand was implicated in 5 of the top 10 areas and contributed significantly to the rapid rise in Medicare spending. The demographic shift and changes in health status accounted for only 17% of the increased spending.
Data on the rise in Medicare spending suggests that we need to move from “high-tech” procedures to “high-value” geriatric care that prevents costly hospitalizations by addressing polypharmacy and falls. Geriatric care is also effective at preventing or delaying costly nursing home placement because it focuses on patient-centered goals, attends to physical function needed to live independently, and addresses the needs of family caregivers.
To those in the inner sanctum of health reform efforts, consider the proven cost and quality outcomes of geriatrics experts like Eric Coleman, Mary Naylor, Chad Boult, and others cited in the recent IOM report, “Retooling for an Aging America."
In a recent Hartford blog post, Chris Langston asked, “Can Geriatrics Survive?” Based on the Medicare expenditure data, I wonder, can Medicare survive without geriatrics? Let’s include geriatrics in the care of our geriatric population. We can’t afford not to.