The Impending Medicare Meteor - Verge of Collision or Convergence of Excellence?

Allow me to grab a stethoscope and listen for the heartbeat of Medicare – the results are as you surmised – faint, erratic and weakening.  The facts are that Americans are living longer, chances are you will suffer from some combination of physical or mental incapacity that will require years of care long before death – and as we all know, living is more expensive than dying.

Medicare is boxed in literally in terms of future trends – the aging population in the United States is driving up Medicare membership from current estimates of 50 million today to 75 million in the next 10 to 12 years.

Medicare based insurers specializing in supplemental plans such as Medicare Part B and Medicare Part C (Medicare Advantage), and Part D (Drugs) are experiencing large flows of “red ink”. These losses are attributed to bottom line increases in underwriting expenses related to unnecessary hospitalizations and medical procedures.

Geriatric Medicine and Medicare are on a collision path – with only 7000 Geriatric Specialist in the United States – too few medical practitioners are serving an exponentially growing segment of the aging population. Future trends are not favorable to filling this gap as medical schools are reporting a shortage of students specializing in Geriatric medicine.

So what are the solutions to saving Medicare and taking care of Mom? Here are the clues: Doctors have heard of if but are too busy to implement it, Pharmaceutical companies think it will reduce sales and profits, Insurers do not how to effectively utilize it and Patients are unaware of it. The solutions are imbedded within the controversial language put forth by the Affordable Care Act – and many remain skeptical as to the benefits.

Let’s jump to future and implement these “controversial” solutions as put forth in the ACA in an effort to take care of mom as the aging process inevitably does its work. There is a 50% that one of your parents will live to age 90 or beyond.  Mom is 92 and has been a widower for 10 years. She is in perfect physical health but has trouble with mobility and does not drive.

Mom needs day to day care from a part time caregiver. Her preventative medical care is being monitored remotely by her doctor. Medications are prescribed using DNA testing or Pharmacogenomics testing http://www.yourgenetest.com/ as a diagnostic tool – this has virtually eliminated the possibility of mom suffering from an “adverse drug reaction” (ADR) and being rushed to the emergency room.

Mom also has trouble swallowing medications to treat various chronic conditions – so her doctor prescribes “bio med” creams that are administered topically. She and her caregiver consult remotely with a nurse practitioner for about 20 minutes each month to make sure her treatments are being administered according to her doctor’s orders. Because her condition is being monitored remotely, a doctor can order additional preventative diagnostic testing without requiring a visit to the office.

Beginning to sound like the Jetson’s? Not at all – the technology is here. The bundling of this medical technology as an effective solution for the preventative care of mom is referred to as Chronic Care Management or CCM. CCM is a metrics based preventative care operating system that directly impacts the doctor patient relationship – and mom – in a positive and healthy way, utilizing existing medical technology.

And the best news of all is that Medicare pays for a majority of the medical services offered within the proposed metrics of CCM.  Medicare is funding CCM for one simple reason – the current “fee for service” doctor / patient / hospital / drugs care model is broken and costing Americans billions of dollars each year in redundant and unnecessary medical services.

To borrow a line from John Lennon, “Imagine” a world where doctors wish to practice Geriatric medicine due to a wide availability of preventative Medicare compensation codes related to treatment metrics under CCM. “Imagine” insurance companies underwriting claims for only necessary medical treatments that ultimately increase profitability and reduce the cost of supplemental plans. “Imagine” mom taking only necessary medications and dosages, without the fear of adverse drug reactions and a critical life event going unnoticed. “Imagine” a world where seniors can age in dignity and live out their days at home or domicile of choice.

Perhaps the real controversy is Mom not having access to cutting edge preventative care technology like CCM, which keeps her healthy and aging in place. Let’s change the world together – the solutions to saving Medicare and taking care of Mom are here. Who wants to make the first move? This article was co-written by David Yates and Dr. Walter Simmons.

David Yates is the CEO of Legacy Care Planning – a consulting firm specializing in   identifying and facilitating solutions to generational planning challenges utilizing a “top down” approach beginning with the Elder. LCP consults with strategic partners on a national scale to implement solutions to long term care planning and critical life events.

David can be contacted at: david@legacycareplanning.com       

Walter N, Simmons, MD, MPH, FACEP is an innovative and entrepreneurial directed healthcare executive. He has extensive formal training and professional experience in developing and managing budgets, team building, providing operational and clinical oversight, and implementing successful safety and quality initiatives. He is a proven change agent for complex urban and rural health care systems, medical groups, health plans, national physician practices, and pre-hospital systems.

Walter can be contacted at: guruofhealthcare@gmail.com