Quality geriatric patient care is possible
I read with great interest the article by Larry Carson in last Sunday's Baltimore Sun that highlighted the failed geriatric practice run by Rebecca Elon and sponsored by Erickson Health. I too am a geriatric physician. I agree with Dr. Elon and so many other voices who warn that our medical system is unsustainable as long as it continues to reward physicians who perform expensive tests and procedures so disproportionately more than primary care physicians who take care of patients and actually save the system money.
But I do not share Dr. Elon's doom about the ability of doctors to deliver quality geriatric care even under our flawed system. I have worked for Erickson Health for the past fourteen years. My average patient's age is over 85, and my patients have complicated medical and social problems. Most of my patient visits are a half hour long, and I spend hours talking on the phone and attending to other services that are accomplished without reimbursement. Still, my practice is sustainable. Dr. Elon suggested that a two-doctor one-nurse practitioner practice would cost $500,000 and bring in $400,000 of revenue, thus operating at a loss. I find this peculiar in that my own revenue, despite the age of my patients and the fact that I have such long visits, exceeds what Dr. Elon suggests two doctors would earn. My expenses are far less than Dr. Elon suggests. I will never be rich practicing quality geriatric medicine, but I can earn a living.
Presently I am starting a geriatric practice (Personal Physician Care) in Howard County that will be capped at a small number of patients, offer long and numerous visits, and allow easy access to care. The key to the success of such a practice is to keep costs down, and I have projected my operating costs to be at or near $100,000. Practice revenue will be sustained simply by practicing good medicine: Patients will come in to see me often for their chronic problems, they will be encouraged to have visits instead of phone calls, and they will be kept out of hospitals by coming to the office as often as is needed to get them through acute illness. Such a system is not only allowed by Medicare, but it will save Medicare, and my patients, a great deal of money, while providing my patients quality and accessible health care. Even if my patients see me ten times a year, it will cost Medicare less than a single average emergency room visit. Some doctors charge patients extra fees for such a service. I think it can be accomplished under the veil of standard insurance.
What I hope to achieve in Howard County for geriatrics can be accomplished by being creative and learning to work within the guidelines of Medicare in unique ways that allow for quality care without excessive cost. That is our task as physicians: to find a way to do the right thing even under adverse conditions. But until the system is changed, and until the government and public realize that if an anesthesiologist earns three times the salary as a geriatric physician who has such a daunting task to care for his/her patients, then students will flock to fields like anesthesia, fewer primary care doctors will be trained, and even ideas like mine will die from lack of a sustainable physician pool. There are glimmers of hope coming from the Obama administration. But if the status quo is maintained, then Dr. Elon's predictions will certainly come to pass, and my small practice will be a last flickering light in a dying endeavor.
- Dr. Andy Lazris, Columba
