It’s one thing to report on a story from the outside. It’s quite another to see it from an insider’s perspective. My recent experience with hip replacement surgery reinforced the importance of care coordination — or lack of it — when confronting a serious or chronic health condition. Importantly, it’s driven home the frustration, confusion, and feelings of helplessness that older patients and their caregivers experience when trying to work within a system that often puts profits before people and the bottom line before common sense.
I’ve joined the growing club of baby boomers who have opted for total joint replacement surgery. Fixing aging, worn-out, arthritic hips and knees (as well as ankles, shoulders, and elbows), are among the most common and cost-effective elective procedures, according to the American Academy of Orthopedic Surgeons. I share my story because there are thousands of others who struggle with similar care challenges who may be less knowledgeable about the health system, perhaps more intimidated when speaking with an insurance company, or are simply adrift when it comes to figuring out care coordination. It doesn’t have to be this way.
Boomers haven’t slowed down like our parents or grandparents did at the same age, this Kaiser Health News story pointed out. Our desire for active lifestyles and a refusal to allow osteoarthritis to slow us down means those worn-out body parts need replacing, David Levine reported in U.S. News & World Report.
So more of us are opting for joint replacement surgery. In 2014, there were 370,770 total hip replacements and 680,150 total knee replacements performed. By 2030, the American Academy of Orthopedic Surgeons projects these procedures will increase by 171% and 189% respectively — meaning an estimated 635,000 hips and 1.28 million knees will be replaced by the end of this decade. These surgeries are happening at younger ages, too. Between 2000 and 2014, the average age of a hip replacement patient is decreased to 64.9 years from 66.3; for knee replacements, it was 65.9 years from a mean of 68, researchers found. Women tend to make up the majority of patients.
An aging population isn’t just a challenge for providers and policymakers in the U.S. – it’s an issue most nations contend with. Experts participating in last week’s webinar from The Commonwealth Fund, Health and Health Care Among Older Adults in 11 Countries, confirm that finding the right balance between clinical and social services, cost-effectiveness and promoting aging in place is tricky, no matter what health system is in place.
The webinar featured key findings from The Commonwealth Fund’s latest International Health Policy Survey, which examined consumer opinions of health systems and care delivery. Experts from France, the United Kingdom and the U.S. provided perspective on the issues. This previous blog post summarizes survey results. Continue reading
Dual eligibles are low-income elderly or disabled people enrolled in both Medicare and Medicaid. The distinctions are sometimes bewildering. It’s easy to confuse which program pays for what, what each agency considers “appropriate” care, what factors go into measuring outcomes and how the separate structures of Medicare and Medicaid affect costs and quality.
According to the Congressional Budget Office, in 2009, the federal and state governments spent more than $250 billion, combined, on health care benefits for the 9 million dual eligibles. There is growing concern about the high costs of dual eligibles and the type of care they receive. They may be treated by a variety of health care providers who are not coordinating their care, potentially increasing costs and worsening outcomes.
Many states are already struggling to meet current Medicaid demand, and as boomers age, more stress will be placed on an already fragile system. Learn more about dual eligibles and what issues to look for in your state with this tip sheet.
Image by homesower via flickr.
Older patients like the kind of team care delivered in medical homes and most of those who get this care say it is actually improving their health, according to a new survey released today by the John A. Hartford Foundation. A representative sample of 1,107 adults aged 65 and older were asked about their experiences with patient-centered medical homes show that relatively few patients receive team care but more want it; and those who have experience with it like it and believe it improves health status.
Even among older adults not receiving this type of care, 61 percent say they believe team care would improve their health, and 73 percent would want this type of care, the survey found.
“The weakness of care coordination in our health care system represents a clear and present danger to many older patients, causing avoidable harm, errors, complications, overtreatment, and hospital readmissions,” said Christopher Langston, Ph.D., program director of the John A. Hartford Foundation. Continue reading