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 New Yorkers probably are not that much sicker than their New England
neighbors. Instead, the statistic reflects the wide variation in the
way healthcare is delivered to older adults around the United
States.
The Dartmouth Institute for Health Policy and Clinical Practice
recently issued a report card on how the United States provides
healthcare to seniors by region. Using Medicare enrollment and
claims data from 2012, the report compares regions on such factors
as where seniors spend the most time with doctors, where they are
most likely to be hospitalized, or be subjected to unnecessary tests
or risky medications.
The report also points to ways seniors - or children helping to care
for elderly parents - can navigate the healthcare system to receive
better care. The research is being used to discover whether best
practices are being used - and where. The answers vary widely across
the country.
Consider the following high and low measurements:
* In York, Pennsylvania, 73.4 percent of seniors had a primary care
physician as their predominant healthcare provider who coordinated
all their care, compared with just 42.6 percent in Metairie,
Louisiana. The national average was 56.9 percent.
Research has shown that regions with a greater proportion of care
provided by primary care physicians tended to have lower costs,
higher quality, and lower rates of avoidable hospitalizations.
* In Clearwater, Florida, 26.1 percent of seniors had an annual
wellness checkup, compared with just 1.2 percent in Meridian,
Mississippi. Under the Affordable Care Act, all Medicare enrollees
are entitled to a free annual preventive check-up, which includes
personalized prevention planning, an assessment of a patient’s
functional ability and a review of a person’s risk factors for
depression.
Nationally, just 10.7 percent of Medicare beneficiaries took
advantage of the wellness visit in 2012 - a number that should be
far higher.
* In Fort Lauderdale, Florida, patients saw an average of 4.7
clinicians in 2012, compared with just 2.4 in Bangor, Maine (the
national average was 3.4). Here, less is more - it is a measure of
the complexity and fragmentation of care a beneficiary is receiving.
More providers translates into greater rates of overuse and misuse
of care, duplication of services and higher risk of
communication-related risks and errors, according to the report.
* Thirty percent of male seniors over age 75 in Miami were screened
for prostate cancer, despite a 2008 recommendation by the U.S.
Preventive Services Task Force that the test not be done on men
above that age. In Casper, Wyoming, the rate is 9.9 percent (U.S.
average: 19.5 percent.)
Current best-practice thinking is that benefits of the screening do
not outweigh the harms, including patient worry about false-positive
results, invasive follow-up tests and treatment with side effects.
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* The practice of placing a feeding tube in patients with advanced
dementia has been widely discredited as not prolonging life or
improving outcomes, yet it happened in 14.2 percent of cases in Lake
Charles, Louisiana, in 2012. In Portland, Oregon, just 1.3 percent
of patients received a feeding tube, and the national average was 6
percent.
The wide variation in these numbers points to a need for more
coordination of care through primary care physicians with expertise
caring for elderly patients, said Dr. Julie P.W. Bynum, associate
professor at the Geisel School of Medicine at Dartmouth College and
the report’s lead author.
“As you age, you have lots of different medical problems competing
against one another,” she said. “Having someone who can coordinate
all the different doctors is important. If you have two or three
diseases, you want the whole person treated.”
If you are not sure your doctor is playing that role, Bynum
recommends that you ask her a simple question: “Are you the doctor
to whom I should have all my records sent? Do all the records come
to your office?”
Bynum also urges patients and their families to assert themselves
more when it comes to healthcare decision-making. And if you feel
like healthcare is eating up too much of your time, ask your doctor
is there is a way to schedule things more efficiently, she adds.
"Can you get your lab tests done one day a year instead of six?”
Finally, Bynum offers a reminder about annual wellness checkups.
“It’s a new benefit - so it’s important to know that you can ask for
it.”
RESOURCES
For information on the healthcare system's performance where you
live, visit this interactive map produced by the Dartmouth Institute
(http://bit.ly/1QHzM0t). A good free guide on how to talk with your
doctor is available from the National Institute of Aging
(http://1.usa.gov/1LUF2fD). The Health in Aging Foundation offers
guidance on medications that elderly patients should avoid (http://bit.ly/1LRfbXt).
(Editing by Lauren Young and Matthew Lewis)
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