Every healthcare market is a local phenomenon, so not every senior receives care in the same way.
Here in southern Ohio, for example, Dayton has a markedly different market dynamic than ours here in Cincinnati (where healthcare is determined by the hospital network you belong to). However, there are a few trends in senior healthcare that we expect to remain the same across the board, whether you live in Dayton, Cincinnati, or Colorado Springs.
Senior Healthcare in a Post-Affordable Care System
Because the current economic climate is driving a lot of the changes in senior healthcare right now, many of the changes we’ll see in the near future will have to do with how seniors will be able to pay for and receive care and services.
In Cincinnati, our hospitals have been folding the doctors they employ directly into their system to create their very own healthcare networks. Seniors who visit GPs in the Mercy network are referred to other doctors in that same system when they must see specialists or have surgery, and likewise for other networks like Christ Hospital or TriHealth.
Until now, senior care has been very much limited by the profit that hospitals and insurance companies could make by keeping an older adult within their network. As a senior’s healthcare is, for the most part, covered by Medicare, there is a certain amount of money that hospitals and insurance companies can make from older adults.
Referrals, admission, readmission, and elective procedures have been in part determined by potential revenues. However, with the introduction of the Affordable Care Act and subsequent legislation, reforms are already beginning to be reflected in senior healthcare, reshaping how delivery models operate and creating a better healthcare experience.
A Tangible Step in Healthcare Reform
In 2013, the hospital readmission penalty went into effect and senior healthcare is now seeing the first tangible step in reform.
Through this penalty, hospitals are being held responsible for the quality of care they provide.
The readmission clause stipulates that hospitals cannot benefit financially from readmitting Medicare patients who have received initial care within a certain period of time prior to the readmission and may even be required to offer reimbursement once they go above a certain rate of readmission. This means that, if they want to see revenues, hospitals must make more of an effort to ensure that seniors receive a better quality of treatment the first time around.
In furthering this goal of lower readmission rates, hospitals have begun working more closely with skilled nursing facilities and rehabilitation centers like the Deupree Cottages to provide post-acute care that helps older adults make a safe and healthy transition home after a hospital stay.
We’re working with clinical staff at local hospitals to establish standardized protocols that help the whole senior care system better serve older adults from initial hospital stay to discharge into post-acute care and even the home of the senior.
What Seniors Can Expect from a Reformed Healthcare System
There’s only so much money that can go into healthcare, and today’s system is too fragmented and inefficient—some experts say about 25-30% of the current system is inefficient. Different care models are going to evolve in order to optimize the limited revenues from Medicare.
In Cincinnati, we’re already seeing how hospitals are coming together with other senior care providers to offer a better healthcare experience, and even more change is on the horizon. There will still be self-contained systems that are run by hospital networks, where hospital systems are health plans in themselves, but services will be more coherent and effective within those enclosed systems, and some hospitals may begin to break away from their networks.
Ultimately, it will become seniors themselves who determine the path their healthcare will take, choosing those networks, health plans, and services that are best able to meet their needs.
Image Credit: José Goulão