A recent study conducted by The Dartmouth Institute for Health Policy and Clinical Practice set out to grade healthcare quality for seniors across the US. By comparing Medicare data for beneficiaries in different regions, the researchers discovered that where you live has a profound impact on the type of treatment your receive, and the quality of that treatment. Here is an overview of some of the key differences found when studying location and medical care for seniors.
Though the study began by issuing a report card by region, the findings suggested wildly different levels of care from city to city, even in the same region.
For seniors living in Manhattan, the average for time spent on doctor visits or in a hospital was 25 days per year. In Lebanon, New Hampshire, a city of about 14 thousand, that average dipped to less than 10 days per year.
Of York, Pennsylvania seniors, about 73 percent used their primary care physician as their predominant healthcare provider and trusted them to coordinate their care. That's the highest such percentage in the nation, according to the study. The lowest, 42.6 percent, was found in Metarie, Louisiana. The national average came in at just under 57 percent.
Those numbers are particularly important because research has also shown that when primary care physicians are more involved with care, patients benefit in a number of ways. Areas in this study with higher percentages of seniors using their primary care physician to coordinate their care tended to also have lower costs, higher quality, and lower rates of hospitalization.
Under the Affordable Care Act, Medicare enrollees are entitled to a free preventative check-up each year. This can include personalized prevention planning, an assessment of the patient's functional ability, and a review of their risk factors for depression. In 2012, only 10.7 percent of Medicare beneficaries took advantage of this benefit. That includes a national low of just 1.2 percent in Meridian, Mississippi, and a national high of 26.1 percent of seniors in Clearwater, Florida.
Typically, when a patient sees more clinicians, there's a higher risk of miscommunication, duplication of services, and misuse, or overuse of care. In most cases, the fewer medical professionals involved in treatment of a single individual, the better the quality of their care will be. That's obviously not always the case, and not realistic for every patient to limit their care to one or two clinicians, but for this study, a lower number of clinicians was regarded as the better option. The national average for seniors was 3.4 clinicians seen in a single year. In Fort Lauderdale, Florida, patients saw nearly 5 clinicians annually on average. Meanwhile, in Bangor, Maine, patients visited 2.4 clinicians on average each year.
In 2008, the US Preventative Services Task Force recommended that prostrate cancer screenings should not be done for males over the age of 75. The belief is that the harm outweighs the benefits. There are concerns over invasive follow up testing, treatments and their side effects, and the stress and worry false-positives can inflict. Partly due to these recommendations, by 2012, the national average for these screenings on males over 75 dropped to under 20 percent of the qualifying US population. It was as low as 9.9 percent in Casper, Wyoming, but in Miami, Florida, 30 percent of males over 75 were still being screened for prostate cancer.
In a similar case, research has shown that feeding tubes don't prolong life or improve outcomes for patients with advanced dementia. Despite this, more than 14 percent of advanced dementia patients in Lake Charles, Louisiana received a feeding tube. That's far above the national average of 6 percent, and the lowest rate in the nation of 1.3 percent, found in Portland, Oregon.
Experts interpret these findings as proof that, as seniors develop multiple ailments and illnesses, and more care is required, it becomes increasingly important to have a coordinating physician or medical professional to oversee comprehensive care in order to ensure that all care is coordinated correctly and successfully. This will also help ensure that current best practices become more wide spread and are used throughout the country, rather than sporadically in some areas.
At Cura-HPC, we help coordinate palliative and hospice care for patients with life limiting illnesses. To learn more about our services, call us at (800)797-3839.