However, much more funding to support preventive care research is urgently needed,” he says. That is especially true given that late last year Congress slashed all $30.5 million from the 2006 federal budget, which would have provided training and incentives for geriatric preventive health providers, such as doctors, dentists, dietitians, and social workers.
Complex government regulations regarding fee reimbursement can make it hard for doctors to provide preventive care. “An annual physical does not have a reimbursement code from Medicare. Only about 20 percent of older people get such a physical. I favor it because it lets me address patients’ needs.
“For example, if I see an 85-year-old here in Sedgebrook’s Medical Center who has arthritis developing in his hip, I can suggest an exercise program in the on-site Fitness Center that might help,” says Elliott Kroger, M.D., Erickson HealthSM physician at Sedgebrook, a community in Illinois built and managed by Erickson. The tremendous savings offered by true preventive care is becoming too attractive for everyone in the health care industry to ignore. “It makes much more sense to spend relatively few dollars on a bone density test, plus training classes to prevent an individual from falling, instead of $40,000 to repair their hip fracture,” says Narrett.
Taler agrees. He is co-founder of a program in D.C. called HouseCalls, which brings physicians to the 5 or 10 percent of older people who aren’t well enough to come to the doctor. “It makes more sense to pay $100 for a house call instead of paying for an emergency room visit which, with 9-1-1 costs, can cost $2,000,” he says. That $2,000 gets especially costly when one considers the results of one four-year study: 20 percent of all hospitalizations for Medicare-age people were preventable.
Types of Preventive Care
Taler says there are actually several layers of preventive medicine. “There is primary preventive care, in which you encourage healthy lifestyle choices to prevent (as much as possible) certain conditions, like high blood pressure or diabetes. Secondary preventive care initiates screening tools to catch potential problems before they become chronic,” he says. Among the latter are blood sugar and cholesterol tests. For many older people, the third level of preventive care on Taler’s list is even more prevalent. “They already have a chronic condition, like diabetes. The goal at that point is to prevent additional problems, like high blood pressure, from occurring,” he says.
What’s Being Done
Within the Erickson HealthSM system there are many techniques for providing various levels of preventive care. There are regular screenings for heart disease, blood pressure, bone density, sugar levels, and more. Easy access to numerous fitness activities (including yoga, dancing, and tai chi). A Fitness Center that meets International Council on Active Aging standards for exercise centers for older adults is supervised and gives residents a wide range of health-enhancing options.
There are more aggressive preventive programs, like the Fall-Proof program available in many communities built and managed by Erickson. (See the May ’06 story online at
www.EricksonTribune.com.) It is designed to enhance balance and strength, and prevent falls which cause 1.5 million fractures each year in people age 65 and older. If you are not a resident of a community built and managed by Erickson, and don’t have access to the aforementioned preventive options, don’t despair. A little research may find one or more in your area.
Consider Taler’s HouseCalls program, whose main focus is tertiary prevention. It is a preventive health plan for older adults that hasn’t waited for HHS funding to sprout. “Each doctor can only see about four or five patients in a half-day, so you can’t generate the income to cover an office. That’s why the program runs out of our hospital. If you support this population, you actually generate revenue down the line for the hospital; you create loyalty,” says Taler.
Another preventive program is PEPPI, the Peer Exercise Program to Promote Independence sponsored by local Area Agencies on Aging (AAA). It is more of a primary preventative; older adults lead their peers in exercises (including simple walking) to promote and maintain their fitness. Check your phone book’s blue pages or go online for links to local AAAs at www.n4a.org.
The Time to Invest Is Now
“More funding in preventive care by government, business, and the non-profit sector is urgently needed if we are to begin to address the widely anticipated deficit associated with current Social Security, Medicare, and Medicaid entitlements. We need to invest substantially in this area, soon,” says Parrish.
“Ultimately, providing good preventive care to older Americans will save money for the taxpayers who fund the Medicare budget. Without such care, the Congressional Budget Office estimates that the budget is currently projected to grow from 372 billion in 2006, to more than $900 billion in ten years,” says Narrett.