Trying to provide medical care for the elderly is what Dr. Rebecca Elon calls "government-induced market failure," since low federal Medicare payments ensure a geriatric practice will lose money on every patient.
With primary care doctors fading away and medical costs rising while insurance payments don't keep pace, it's time for patients and doctors to try something like a patient-owned, nonprofit geriatric practice, without waiting for the federal government to act, Elon said.
A geriatric practice with two doctors and one nurse practitioner would have minimum operating expenses of about $500,000 a year, she said, while revenues would likely be only $400,000.
That's why, as she prepares for the closing July 1 of Erickson Health Medical Center, a failed one-year experiment in providing health care for seniors in Columbia away from the big elder housing company's well-known residential campuses, she's plumbing patient interest in helping start that kind of a medical home for seniors in Howard County.
"Everything in medicine is focused on profit or margin," she told a group of about 75 Erickson patients and observers at a recent meeting at the Lorien Columbia nursing home, where Erickson Health is located. "Margin," she said, is a euphemism for the profits made by so-called nonprofit hospitals and insurance companies. She told patients to find another doctor promptly, though, because her new practice can't be organized by July 1, when Erickson Health will close.
The saying in geriatric medicine used to be "no margin, no mission," Elon said, describing how making a profit was considered vital to allowing doctors to treat patients as they wanted. But the current reality is different.
"The margin became the mission," she said.
Edie Hough, 70, of Ellicott City, said she just joined the Erickson practice last winter.
"I'm very upset," she said, at the prospect of again having to find a new doctor. She left her last doctor because "half the office was devoted to giving botox injections" and other cosmetic services. "I thought I'd found a home for the next 20 years."
Others said Elon's plan, though unformed, is encouraging.
"I think it's exciting enough to be tried," said Ted Myerson, president of United Seniors of Maryland, who is not an Elon patient but attended the meeting.
Paul R. Willging, a geriatric specialist who teaches at the Johns Hopkins School of Medicine and heads Howard County's Commission on Aging, also attended, and agreed with Myerson, a commission member.
