Health Care is ‘Overwhelmingly Complex’ For Seniors

Health Care is ‘Overwhelmingly Complex’ For Seniors

Adults tend to need more medical care as they age, but arranging and managing that care can be overwhelming for seniors. A recent study suggests that receiving in-person care and treatment can require “substantial time, effort, and cost” for older adults and their spouses or caregivers.

The study, published in the Annals of Internal Medicine, found that older adults who have Medicare spend an average of three weeks in the year visiting doctors, undergoing tests, going to the emergency room, spending time in hospitals or rehabilitation facilities, and receiving other types of medical care.

To determine the number of days spent receiving care, researchers from Brigham and Women’s Hospital and Harvard University reviewed data from 6,619 adults aged 65 and older who responded to the 2019 Medicare Current Beneficiary Survey. The data was linked to Medicare claims.

The data revealed that older adults had an average of 17.3 ambulatory contact days in the year, with 20.7 total contact days. However, around 11 percent of older patients had 50 or more total contact days. Most contact days were spent on ambulatory care, which included an average of:

  • 5.7 days for specialty care visits
  • 5.7 days for treatments
  • 5.3 days for tests
  • 3.5 days for primary care visits
  • 2.6 days for imaging
  • 2.5 days for procedures

It gets even more complex when older patients find themselves juggling regular appointments and tests if they have three or more specialists.

“The good news is that we know so much more and can do so much more for people with various conditions,” Thomas H. Lee, chief medical officer at Press Ganey, a consulting firm that tracks patients’ experiences with health care, told KFF Health News. “The bad news is the system has gotten overwhelmingly complex.”

It’s also frustrating when they cannot receive treatment even from one specialist. Susanne Gilliam, 67, experienced this firsthand when she needed to get treatment for her injured ankle and knee.

In January, Gilliam slipped and fell on a patch of black ice in the driveway of her Sudbury, Massachusetts, home. Later that afternoon, Gilliam was able to see the orthopedic surgeon, who managed previous problems she had with her left knee. But, when she got there, Gilliam said he told her: “I don’t do ankles.”

So, he referred her to an ankle specialist who ordered a new set of X-rays and an MRI. Gilliam asked if she could get the scans at a hospital near her home. When she called the hospital for an appointment, she was told the doctor had not yet sent the referral. Gilliam made several calls before the hospital received the referral.

Gilliam needed physical therapy, but since therapists work on only one body part per session, she had separate visits for her knee and her ankle several times a week.

“The burden of arranging everything I need—it’s huge,” Gilliam told KFF Health News. “It leaves you with such a sense of mental and physical exhaustion.”

Gilliam is not alone. Medical complexity for seniors is a “huge problem” in the United States, according to Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor.

“The medical system is overburdened coming out of the pandemic, and there is a shortage of both doctors and nurses,” Dr. Siegel told Fox News Digital.

On top of that, the healthcare needs of older adults are increasing, especially with technological advances in helping to manage chronic illness, Dr. Siegel noted.

“At the same time, the extensiveness of Medicare coverage is shrinking, along with providers who can work with it,” Dr. Siegel explained. “And the barriers to getting needed procedures and treatments are increasing, along with out-of-pocket costs.”

Some older adults are attempting to break through these barriers by reaching out to people like Dr. Shana Johnson, a physical medicine and rehabilitation physician in Scottsdale, Arizona.

“Every step of the health care system is laden with complexity—from scheduling an appointment with a provider that accepts your insurance to filling a prescription that you can afford to discerning which medical tests you actually need,” Dr. Johnson told Fox News Digital.

Dr. Johnson has taken on a new role as an independent healthcare system consultant and already has her work cut out for her. For example, one patient contacted Dr. Johnson because her primary care doctor was unable to refer her to a rheumatologist.

“First, her doctor sent her to the university medical center,” Dr. Johnson said. “They denied the referral because their appointment slots were reserved for high-complexity cases, and her case was deemed not difficult enough.”

The patient was then referred to a private rheumatology practice, which denied the referral because the practice did not accept Medicaid insurance. After speaking with the patient, Dr. Johnson suspected she had fibromyalgia, and this could potentially expand the number of specialists to contact.

So, the patient was referred to a pain clinic in a large hospital system, but Dr. Johnson said the referral was denied because the pain clinic was too busy with opioid patients and could not accept outside referrals. Besides that, the patient’s doctor did not work for the hospital system.

“Next, I tried the general physical medicine and rehabilitation clinic,” Johnson said. “They said no because she was a better fit for the pain clinic that declined to see her.”

By this time, the patient had been waiting—in pain—for five months trying to get a diagnosis—and treatment hadn’t even started. Johnson noted, “This patient’s struggles are not unique—they are the usual.”

Unfortunately, some older adults who face the “treatment burden” that comes with coordinating their healthcare and managing medical costs may choose to forego care, Victor Montori, a professor of medicine at the Mayo Clinic in Rochester, Minnesota, told KFF Health News.

Dr. Elizabeth Rogers, an assistant professor of internal medicine at the University of Minnesota Medical School, provided tips to KFF Health News for making care more accessible for older adults:

  • Give feedback to doctors if a treatment plan doesn’t seem sustainable. Also, patients should discuss what they might gain and lose by forgoing certain tests or treatments. 
  • Discuss which medical interactions are essential and which can be skipped. Based on these discussions, doctors might be able to make adjustments to treatment plans or prescriptions. 
  • Find out if medical centers have social workers or “patient navigators” on staff who can help coordinate and consolidate appointments and arrange transportation if necessary.

Dr. Rogers also advises older adults to ask questions to make sure that they understand their doctor’s directions. 

Dr. Ishani Ganguli, an associate professor of medicine at Harvard Medical School, who led the recent study, told KFF Health News that she would ask a clinician, ‘If I chose this treatment option, what does that mean not only for my cancer or heart disease but also for the time I’ll spend getting care?’ If they don’t have an answer, ask if they can come up with an estimate.”  

Source Links:

https://www.foxnews.com/health/health-care-overwhelmingly-complex-older-adults-experts-increasing-hurdle
https://www.ajmc.com/view/older-adults-in-traditional-medicare-spend-weeks-per-year-on-health-care-contact-days
https://www.acpjournals.org/doi/10.7326/M23-2331
https://kffhealthnews.org/news/article/medical-care-exhausting-older-patients/

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