Geriatric Programs

In the last decade, more hospitals have taken note of the cost savings and patient loyalty affiliated with specialized geriatric units, including geriatric-specific service lines and emergency rooms. With the highest hospitalization rates belonging to patients older than 65, arrays of specialized geriatric units could be untapped sources of revenue for some hospitals. In addition, healthcare facilities that reinforce their existing geriatric programs or implement them can further their resources in the highest yield population. In 2012, the University of California in San Francisco performed a study that suggested specialized units, such as geriatric programs, could save Medicare more than $6 Billion per year—nearly 1% of the federal health program’s expenses during this time.

Cost Savings

Patients over the age of 65 account for more yearly hospital discharges than any other age demographic while also staying an average of two days longer in any hospital short-stay than adults aged 15-44. Eldercare management ensures that hospital resources are optimized for geriatric programs and services. When specially trained providers care for elderly patients, the average length of stay for this age group decreases along with costs (source).

Separate from the cost savings for the hospital and CMS associated with opening a geriatrics program, these new high yield population service lines will also generate more income for the hospital.

Program Information

Inpatient acute-care elderly (ACE) units may have different routines, such as not waking patients throughout the night for medications unless necessary. These small but significant differences from other units can notably affect costs associated with the length of geriatric stays. When spaces are designed specifically for the elderly, many common complications these patients face during hospitalization can be mitigated, and the staff can be more prepared. Not all seniors need the more ‘involved’ services that geriatric programs provide, so these units must prepare for and have the capabilities to deliver care for a wide breadth in the health needs of their patients.

For example, Mount Sinai Hospital opened New York City’s first geriatric outpatient emergency department with wooden floors to avoid the glares that a gloss finish might cause. Though these glares might suggest the floors are clean and well-kept, to aging eyes, they can present as holes in the ground and produce disorientation that leads to falls. The extra steps to customize these settings or update them to prevent further injury and decrease chances of later readmission can save hospitals high costs down the road. In addition, many geriatric emergency departments around the country are adding geriatrics-trained nursing staff to assess whether some of their older patients need inpatient care at all. Unfortunately, more than 30% of adults over the age of 65 are discharged from hospitals with health issues they sustained during their stay. Some geriatric programs have expanded to home and nursing home visits to mitigate this problem. Successful practices of home visits can be found here at point 3.

Using data from over 400 hospitals, the CEO of ObjectiveHealth in 2012, Dr. Russ Richmond, identified the three fastest-growing diagnosis groups for patients over the age of 65—sports medicine, orthopedics, and cardiology—suggesting that a possible market opening for senior programs is keeping them healthy to ensure they can remain active and involved in their activities, like golf and tennis. Presenting your hospital as a place to improve and preserve your patients’ health rather than as a place to go when a patient is sick could be vital to growing new or existing geriatric programs. Among other benefits, geriatric orthopedic programs may also help hospitals meet CMS-mandated coordinated care and episode-payment programs.

Staffing Requirements

A team approach to geriatrics is vital to constructing a successful geriatrics program. Care specialists whose knowledge and attention focus more on geriatric patients may pick up on behaviors specific to the elderly in different conditions, resulting in more efficient and effective care management plans. At Abington Memorial in Philadelphia, their senior program staffs a medical director, nursing director, and administrative director. Unfortunately, there is currently a significant geriatrician shortage that could be partly due to their pay compared to other medical specialties in combination with the health complexities of their patients. If a hospital can staff a geriatrician, there are many opportunities for cost savings and improved patient satisfaction and outcomes.

Small hospitals without the resources to staff a geriatrician will sometimes partner with their local nursing homes or acute care facilities. Physicians who service these homes and rehabilitation centers have access to the knowledge of CNAs and RNs who work with geriatric patients daily. This information is a valuable tool that your hospitals’ physicians can use to understand better your local geriatric population and how to best care for their health needs. In addition, the resources used in these nursing facilities can be implemented into an existing clinic or emergency department.

Many geriatric-specific units also staff to provide specialized care management and consulting services to the patients’ families (see Building From Within: 5 Strategies for Growing a Geriatrics Program). Depending on the condition of their patients, they may need help facing the sometimes-difficult decisions the next step of their care brings. Adding consultants to the service lines aids in the continuum of care without pulling nursing resources from the unit. In addition, building a repository of resources for the family members helps them understand the differences between rehabilitative services, retirement communities, nursing homes, and post-acute care settings.

Beginning with a provider who expresses a passion for treating older adults, allocating adequate time for geriatric patients’ appointments is essential to providing effective care. Longer appointment times for these patients with multiple comorbidities lead to increased patient satisfaction and a better understanding of their conditions. Most providers who provide effective geriatric care see between 13 to 15 patients in an eight-hour workday. This breakdown allows quick, straightforward visits and longer visits with patients who might be new or have complex medical histories. In addition, the 13-15 patients per day allow the geriatric provider to see more complicated cases without burning out and can help grow the practice.

The geriatric provider must be fairly compensated in their salary, relative value unit (RVU) plan (created by the hospital’s accounting and human resource departments), and knowledge of evaluation and management (E/M) guidelines and time-based billing. In addition, some geriatric practices offer a recruitment bonus for providers who help expand their geriatric teams.

Providers who travel to do in-home or nursing home visits for patients must also receive fair compensation for their travel, travel time, and whether it is salary, stipend, RVU, or a combination. In areas with low-income populations or without public transportation, hospitals with staff who provide in-home care and care in nursing homes can gain patients they might have otherwise lost.

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