The United States is experiencing a wave of an aging population. Warmly referred to as the Silver Tsunami, the population of seniors (65 and over) in the US has passed 50 million for the first time in history and is projected to reach over 70 million in the next 25 years[1]. The looming 65th birthdays of many baby boomers, combined with longer life expectancies and improved healthcare, doesn’t show any signs of a calm in the storm.
With the increase in the number of older Americans comes the increase in need for geriatric care. However, geriatrics is not the most glamorous specialty in the health care field. In addition to medical school and a standard residency program, to practice geriatrics, a student must also become board certified, complete a geriatric fellowship and then obtain a certification in geriatric medicine over a period of an additional 8 to 11 years. After all of that, a practicing geriatrician is often not financially rewarded.
Because most elderly patients are enrolled in Medicare, reimbursement is generally lower than for privately insured patients. Thus, geriatrics is the only specialty in which the doctor often doesn’t get paid more for having completed a fellowship. Lack of financial incentive, along with general distaste for the specialty, makes the necessary increase of geriatricians seem unlikely.
On bright spot for geriatricians is the Federally Qualified Health Center (FQHC) program. One of the benefits of FQHC or FQHC Look-Alike status is enhanced reimbursement for Medicare services through a Prospective Payment System (PPS). The Medicare PPS is one of the reasons that the nation’s FQHCs are expected to serve as medical homes for an ever-increasing number of aging baby boomers. This, along with generous federal loan repayment benefits, should make FQHCs a preferred employment option for many geriatricians.
According to a 2016 survey employed by the ACGME (the Accreditation Council for Graduate Medical Education), there are 5,227 active geriatricians in the United States[2]. About 30% of the population 65 and older require some type of geriatric care[3]. With our elderly population at 50 million and growing, that’s over 15 million people in need. Since each certified geriatrician can effectively treat up to 700 patients[4], we would need about 21,500 certified geriatricians to care for the Silver Tsunami – 4 times the current supply! In addition, there was a 21% decrease in the number of first-year geriatric residents from
2010 to 2015. This means that the pool of certified doctors is now shrinking at the same rate the need for them is growing[5].
This widening gap between patients who need specialized care and those able to provide it is nothing to be overlooked. It appears that the only way to incentivize medical students to proceed with this fellowship program is to increase pay. While this seems unlikely under the traditional payment system, the move from volume to value-based reimbursement provides a measure of hope that supply may eventually catch up to demand.
In the meantime, elderly patients are obtaining care from general practitioners. So, how can general practitioners tailor their businesses to better fit the ever-aging population now?
Consider the process for an elderly person to obtain care from your facility. First, she must schedule an appointment. Does she have a computer to access your website? If she calls to schedule an appointment, will staff be able to accommodate her potential hearing issues? Once the appointment is scheduled, she must be able to get to the office. If she has no family members to help, is there a public transportation system that will allow her to make it to the appointment? If so, does it accommodate a walker or wheelchair? Is your facility in a location where elderly patients feel safe crossing the parking lot by themselves? Once they arrive at the facility, can they make it to the entrance with a walker? Does your staff take their unique needs into account during interactions? Do you have doctors who are able to care for their specific needs?
These often overlooked factors present major barriers to older Americans obtaining care. In a national study of over 4,500 elderly Americans (mean age 76) , the following were identified as the most common barriers to seeking care:
· Doctor not responsive to concerns
· Medical bills
· Transportation difficulty
· Fear for safety on streets[6]
Thus, these are the areas that every facility should evaluate when attempting to make improvements to the quality of care provided to this new influx of older patients.
All of this can be assessed locally through a Senior Needs Assessment, a Community Needs Assessment targeted specifically for the elderly population. With this tool, you can assess the extent to which your community is capable of caring for the elderly. The use of census data or previously surveyed populations is helpful in writing a Senior Needs Assessment. In addition, holding town meetings, interviews, or local surveys specific to your location can help you to focus in on what your community really needs. Performing this assessment is the most efficient way to analyze how to better prepare your facility to cater to the senior community’s needs.
If you haven't done a Needs Assessment in the past three years, or you think you might need some help to uncover the true needs in your community regarding aging seniors, we can help.
[1] The United States Census Bureau. https://www.census.gov/newsroom/press-releases/2017/cb17-100.html
[2] The Association of American Medical Colleges. https://www.aamc.org/data/workforce/reports/458480/1-1-chart.html
[3] American Geriatrics Society. http://www.americangeriatrics.org/
[4] American Geriatrics Society. http://www.americangeriatrics.org/
[5] The Association of American Medical Colleges. https://www.aamc.org/data/workforce/reports/458480/1-1-chart.html
[6] American Public Health Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448535/
Running a successful FQHC is hard work (we know because we’ve done it!)
Health centers present their own unique challenges, which often require expertise in many different areas. Our consultants use their specialized knowledge and network of relationships to help you solve your biggest operational and financial challenges so your health center can thrive.
If you have a problem, chances are we have dealt with something similar or know someone else who has. Our consultants are experienced in all facets of establishing and running a health center, and our clients include established FQHCs, Primary Care Associations (PCAs), and organizations wishing to establish, become or partner with FQHCs.
Learn more about our Clients and Services.
