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National Commission for Quality Long Term Care

National Commission for Quality Long Term Care. Testimony of George Taler, MD Director, Long Term Care Washington Hospital Center Washington, DC Past President, American Academy of Home Care Physicians. Summary. Primary Care & Geriatric Medicine

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National Commission for Quality Long Term Care

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  1. National Commission for Quality Long Term Care Testimony of George Taler, MD Director, Long Term Care Washington Hospital Center Washington, DC Past President, American Academy of Home Care Physicians

  2. Summary • Primary Care & Geriatric Medicine • A different approach to the health care challenges of an aging population • Restructuring health care delivery and health care financing

  3. Median Compensation for Selected Medical Specialties Woo B. N Engl J Med 2006;355:864-866 Bodenheimer T. N Engl J Med 2006;355:861-864

  4. Family Medicine Residency Positions and Number Filled by U.S. Medical School Graduates Bodenheimer T. N Engl J Med 2006;355:861-864

  5. Proportions of Third-Year Internal Medical Residents Choosing Careers as Generalists, Subspecialists, and Hospitalists Bodenheimer T. N Engl J Med 2006;355:861-864

  6. National Medical AssociationGallup Poll of Membership, 2003

  7. Maryland Academy of Family Physicians2005 Practice and Income Survey • 663 Active Members (private practice: 66%) • Median annual income: $103,400 • 37% no change since 2001 • 41% decrease since 2001 • In response: • 16% have increased hours or # of patients/wk • 44% have decreased hours in clinical practice • 35% plan to retire, relocate or change careers

  8. Geriatricians Have GreatestCareer Satisfaction

  9. Changes in Medicare Payments to Physicians 1999-2012

  10. Concentration of Total Annual Medicare Expenditures Among Beneficiaries, 2001 Percent Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services.

  11. High-Cost Medicare Beneficiary Spending Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services. Note: Spending reported in 2005 dollars

  12. Yes, but… Just because you have a bad year, does your bad luck persist and for how long?

  13. Expenditure History of the Top 25% of Medicare Beneficiaries, 1997 Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services.

  14. Distribution of High-Cost Months, 1997-2001 Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services.

  15. Concentration of Total Cumulative Medicare Expenditures Among Beneficiaries, 1997-2001

  16. Targeting the High-Cost User • Diagnostic characteristics • Functional characteristics • Resource utilization history

  17. Prevalence of Chronic Conditions Notes: COPD=Chronic Obstructive Pulmonary Disease, ESRD=End Stage Renal Disease.Data from a 5 percent random sample of fee-for-service (FFS) beneficiaries between 1989 and 1997. Source: CBO preliminary analysis.

  18. Number of Chronic Conditions Predicts High-Cost Status Notes: The 7 conditions considered were: CHF, CAD, COPD, ESRD, Asthma, Diabetes, and Cognitive impairment. Source: CBO preliminary analysis.

  19. Spending for People with Chronic Illnesses and Activity Limitations Sources: Partnership For Solutions, “Chronic Conditions: Making the Case for Ongoing Care,” December 2002; MEPS, 1998.

  20. Service Organization Structure & Process Criteria • Make the HOME the center of health care delivery and social supports • Re-establish the Doctor-Patient relationship • Continuity of care across all settings and over the natural history of illness • Coordinate Medical, Social and Housing services • Match patient goals and processes of care

  21. Life Care Coordination Fees • Layered fee for non-covered services • Comprehensive Geriatric Assessment • Team meetings • Care coordination • Enhanced urgent care services • On-call services • Gap-filling fund • Renewable contingent on performance • Adherence to evidence-based guideline targets • Patient and caregiver satisfaction targets • Reduced costs

  22. “Whose Ox Gets Gored?” • Sponsoring Hospitals • Cover “margin” expectations • Rate incentives for supporting innovation • SNF/ICF • Escalated payments for greater complexity • Decreased payments for custodial care • Incentives for community-based referrals

  23. The “Ask”: How You Can Help • Advocacy for a focused, population-based health care delivery system transformation • Development of population target criteria • Development of new financing mechanisms • Special interdisciplinary training programs • Development of a public-private partnership towards common goals and incentives

  24. “You can judge a civilization by the care it takes of its old and sick people. I want America to pass this test well.” Rep Claude D. Pepper

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