The Case For Accountable Care Organizations To Partner With Geriatric Emergency Departments
Health AffairsFull Text
Older adults—particularly those with complex medical and social needs—are frequent users of medical care, but they are often not well served by America’s fragmented health care system.
Most health care systems, particularly hospitals and other health care facilities, are not organized or operated with the needs of elderly patients in mind.
In an important editorial now nearly a decade old, Harlan Krumholtz, MD, coined the term “post-hospital syndrome,” which describes a period of heightened risk that many Medicare patients face following discharge from the hospital. The elevated risk comes from stresses endemic to being in the hospital including poor sleep, poor nutrition, and physical deconditioning due to long periods of inactivity. Post-hospital syndrome can lead to poor post-discharge outcomes including readmissions unrelated to the original reason for hospitalization.
A growing awareness of the challenges facing older adults in the US health care system has led to calls for “age-friendly health systems” that proactively address the unique needs of geriatric patients such as mobility, cognitive function, appropriate medication management, and decision making based on patients’ goals and priorities. By 2035, nearly 22 percent of the US population will be older than age 65, and 11 percent will be older than age 75. This creates an imperative for increased investment in geriatrics capacity and in age-friendly health care more broadly. But improvement will depend on health systems’ ability to make major changes in culture, process, and priorities.
An important place to promote age-friendly health care is the emergency department (ED), which is the gateway to the hospital for 60 percent of Medicare admissions. A growing interest in making EDs more responsive to the needs of older adults has led to the development of geriatric emergency departments.
In this Forefront article, we describe geriatric emergency departments and the role they can play in reducing potentially avoidable hospitalizations. Traditionally, health systems that were paid primarily based on fee-for-service may not have seen a business case for a model that could reduce inpatient volume, but in today’s health care landscape of frequently full hospitals and staff shortages, diverting patients who are not critically ill to alternative settings is necessary to make room for patients who require hospital-level care. In addition, geriatric emergency departments should be highly attractive to accountable care organizations (ACOs), which have financial incentives to manage Medicare spending. We argue that there is a great opportunity for ACOs and geriatric emergency departments to work together.
Dr. Kevin Biese serves as an Associate Professor of Emergency Medicine (EM) and Internal Medicine, Vice-Chair of Academic Affairs, and Co-Director of the Division of Geriatrics Emergency Medicine at the University of North Carolina (UNC) at Chapel Hill School of Medicine as well as a consultant with West Health. With the support of the John A. Hartford and West Health Foundations, and alongside Dr. Ula Hwang, he serves as Co-PI of the national Geriatric Emergency Department Collaborative. He is grateful to chair the first Board of Governors for the ACEP Geriatric Emergency Department Accreditation Program. His passion is for improved education and systems of care for older adults, and he has published multiple materials in both these areas.