photo by Jeffrey M Levine MD geriatrician

The Patient Protection and Affordable Care Act (HR 3590) purports to contain provisions that will provide for better care for America’s seniors and add stimulus to growth of the field of Geriatrics.  One wonders, however, whether this historic bill will have true impact in stemming the flow of medical doctors away from caring for the elderly.  In fact, some basic flaws in our healthcare system remain untouched.

There is a geriatric education and training provision in Section 5305 that will result in enhancement of teaching, development of curricula and best practices, and expand training for nurses, social workers, pharmacists, and psychologists.  These changes are welcome, particularly if they enhance the funding of academic geriatrics and assist in education of subspecialists regarding care of the elderly.  However, I see limited impact upon practice patterns without more substantial incentives to limit access to expensive, hi-tech modalities that may not improve outcomes. 

Section 5501 was designed to enhance reimbursement for primary care practitioners using a bonus system.  Certain Medicare reimbursement codes submitted by primary care practitioners who furnish 60% of their services using these codes receive a 10% bonus.  It is doubtful, however, that this 10% bonus will even begin to rectify the payment gap that exists between physicians who practice geriatrics and other subspecialists.  The reality is that today’s medical students choose their career path using primarily financial and life-style considerations – something that will not change with health care reform. 

Section 5203, the Health Care Workforce Loan Repayment Program speaks volumes with regard to financial priorities of the President’s Health Care Reform Act.  This section provides loan repayment for pediatrics specialists at a rate five times more than that allotted to appropriations to enhance the geriatrics health professions. 

Some aspects of the Act designed to study where healthcare resources should go are unnecessary when applied to geriatrics.  For example Section 5101 establishes a National Health Care Workforce Commission with will study current and future needs for America’s healthcare workers.  Section 5103 establishes a National Center for Health Care Workforce Analysis.  In fact, previous studies already commissioned and completed have established without question the need for workers in the field of geriatrics, and strategies to address these gaps have already been suggested.

There are indeed aspects of the Patient Protection and Affordable Care Act that will have positive impact on geriatrics.  However there is nothing to curb overuse of technology, and little to level a playing field that devalues care of the elderly in favor of subspecialists.  The new Health Care Reform Act will maintain of the status quo of today’s medical structure in favor of unlimited access to high-technology medicine and the vast disparity in pay between primary care practitioners and subspecialists.   

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Retooling for an Aging America: The Thud that Should Have Been a Bang
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Shakespeare, the Diversity of Aging, and the Need for Geriatrics