Geriatric patients are expensive. For most, it's not a question of if they will require a large amount of high-cost, high-acuity care—it's a question of when and for how long.
The majority of older patients in the US are treated for one or more chronic illnesses. Heart disease, dementia, chronic pain, diverticulosis, renal disease, depression, obesity-related syndromes, diabetes, COPD, and tobacco-linked respiratory conditions are just a few of the treatable but hard-to-manage diagnoses that many seniors deal with on a daily basis. In fact, nearly 1 in 4 non-institutionalized patients over the age of 65 are in only fair to poor health, according to the Centers for Disease Control and Prevention (CDC).
For hospital administrators (especially those at community and rural hospitals, which tend to have higher proportions of elderly patients than do urban hospitals), the challenge has always been how to effectively manage older patients over the long-term, reduce the costs associated with their care and mitigate bouncebacks.
The price of readmission.
Many healthcare organizations have tried to get a better handle on their aging patient populations. Unfortunately, many have also failed. And the latest reports on Medicare reimbursement and penalties show that hospitals are paying—literally—for a lack of strategy to improve engagement with older adults.
Beginning last month, 2,952 hospitals nationwide began receiving lower per-patient payments from Medicare—victims of the Affordable Care Act's Hospital Readmissions Reduction Program, which broadly penalizes providers have unacceptably high readmission rates, according to the Department of Health and Human Services' (DHS) prescribed guidelines.
Of the hospitals facing readmission penalties this year, only 209 were not penalized last year. This has many hospital leaders upset because, they argue, DHS fails to reward progress.
Is it fair?
Even if a healthcare provider manages to lower its readmission rate year over year, it can still be sanctioned if that readmission rate comes in higher than DHS' goal. For community and rural hospitals, or for hospitals in poor areas, this can be devastating.
To illustrate that point, 4 hospitals have been given the maximum readmission penalty every year since the program's inception: Harlan ARH Hospital and Monroe County Medical Center (both in rural Kentucky), Livingston Regional Hospital (in Appalachian Tennessee) and Franklin Medical Center in northeastern Louisiana.
In essence, Medicare continually asks institutions serving some of the nation's most vulnerable populations to do more with less. It's especially vexing for providers who do face that uphill struggle, when some institutions are exempt from being considered for readmission penalties altogether.
Under the program, some hospitals are given automatic pardons solely by virtue of the types of patients they serve—the VA, for instance, serves veterans and is exempt, as are children's hospitals and hospitals with low Medicare patient ratios.
Want to engage your older patients? Enlist their caregivers first.
Meaningful engagement is notoriously difficult to achieve with many elderly patients. Many older patients aren't particularly tech savvy, so social media-based efforts aren't as effective. Traditional communication vectors like TV ads, radio spots, direct mail and print ads don't enjoy the market penetration they did 20 years ago. And realistically, a lot of older patients are infirm enough that they rely on family members or other caregivers to manage their healthcare for them. According to a 2012 study by Pew Research, about 40 percent of US adults provide care for a loved one.
Caregivers represent an influential target audience. They're much more wired in to eHealth and mHealth channels than the average US adult.
Whereas Pew found that only 13 percent of non-caregivers consult online reviews of medications, 24 percent of caregivers do. And although only a third of non-caregiving adults reported having done so, over half of caregiving US adults reported engaging with health-related social media efforts.
c2b solutions included many caregiver questions in its 2015 market research study, the c2b Consumer Diagnostic. The study answered such questions about caregivers:
Media, information source and communications vehicle preferences to guide outreach
Attitudes regarding the role of various healthcare professionals (e.g., physicians, nurses, pharmacists, etc.)
Family members on which caregiving is focused
Sources (bricks & mortar and online) for prescriptions, OTC medicines, Vitamins/Minerals/Supplements, both Usually and Occasionally
Plus many other data points and insights
Armed with these insights, a healthcare provider can better engage caregivers and align with them on excellent care.
Caregivers may represent many community hospitals' last, best hope for mitigating the costs associated with providing care to the elderly. If your organization faces readmission penalties this year, it may be time to take a hard look at your engagement strategy and figure out how you can influence the influencers.