Tuesday, April 15, 2008 Coverage
& Access
U.S. Health Care System Unprepared for Millions of
Baby Boomers Who Are About To Become Eligible for Medicare
The U.S. health care work force is "too
small and woefully unprepared" to meet the geriatric care needs of the 78
million aging baby boomers, according to a report released on Monday by
the Institute of Medicine,
the Wall Street Journal reports (Francis/Fuhrmans, Wall
Street Journal, 4/15). The report, titled "Retooling for an Aging
America: Building the Health Care Workforce," estimates that currently
there is one certified geriatrician for every 2,500 seniors. In three
years, the first of the baby boomers will turn 65 years old, and by 2030,
all 78 million will have reached that age -- nearly double the number of
people older than age 65 in 2005, according to the report. The U.S. would
need 36,000 geriatricians by 2030 to meet the need, according to the
report. The report says there are 7,128 certified geriatricians today (La
Ganga, Los Angeles Times, 4/15).
IOM
attributes much of the shortfall to misplaced financial incentives. The
average pay in 2005 for a physician specializing in geriatrics was
$163,000, compared with $175,000 for a general internist with no specialty
training. Other specialists can earn more than twice as much (Wall
Street Journal, 4/15). The report also says that Medicare's low
reimbursement rates; focus on treating short-term problems, rather than
managing chronic conditions; and lack of coverage for preventive care may
exacerbate the problem (Schmid, AP/San Francisco Chronicle, 4/15).
The
report also cites a high rate of turnover among direct-care workers, such
as nurse's aides and home health aides, and lack of knowledge by "informal
caregivers," such as family members, friends and others who provide care
for seniors in their homes. According to the report, 71% of nurse's aides
change their jobs annually, and as many as 90% of home health aides find a
new job within two years (Reichard, CQ HealthBeat, 4/14). The report says that
90% of seniors receiving care at home get help from family and friends and
80% rely solely on them.
Recommendations
Although the report calls for increasing the
number of geriatricians, it also recommends that physicians, nurses and
others receive more geriatric training during their general medical
education (Wall Street Journal, 4/15). In addition, the
report recommends that Medicare, Medicaid and private insurers increase
payment for geriatric care to attract workers. The report says that
creating initiatives at local hospitals and community groups to help train
informal caregivers could help the situation. It also recommends that
state attorneys general recognize such training at hospitals as
justification for their tax-exempt status (CQ HealthBeat,
4/14). In addition, IOM recommends that states and the federal government
create programs that would forgive student loans for people caring for
older adults (Los Angeles Times, 4/15).
"This could be
seen as evidence that our society places little value on the expertise
needed to care for vulnerable, frail older Americans," John Rowe, chair of
the committee that wrote the report and a former chair and CEO of Aetna, said. He
added, "We're not saying every (old) person needs a geriatrician any more
than every person who has a heart needs a cardiologist, but we need to
enhance the care they do receive" (Wall Street Journal,
4/15).
Senate
Finance Committee Chair Max Baucus (D-Mont.) on Friday said that he
wants to increase Medicare payments to primary care physicians,
which include geriatricians, as part of a Medicare package due on the
Senate floor in mid-May. AARP said it is lobbying for a bill (S
2708), co-sponsored by Sens. Barbara Boxer (D-Calif.) and Susan
Collins (R-Maine), that would bolster geriatric and long-term care
training. The legislation also would create a panel that would track
geriatric and long-term care and issue recommendations for improving the
fields (CQ HealthBeat, 4/14).
A
summary of the report is available online.