Focusing on preventable conditions (e.g., pressure ulcers, urinary tract infections, etc.) to which elderly patients are particularly susceptible can go a long way toward keeping patients out of the ED and ensuring positive margins for the service line, he says.
Success Key No. 2: New models of care
In 1994, Summa Health System, an integrated delivery system covering 1,235 beds in Ohio, launched a 34-bed Acute Care for Elders (ACE) program with the goal of studying the model—based on a concept that came out of University Hospitals of Cleveland—in a community hospital setting.
Everything about ACE units, from carpeted floors and large-print to care coordination and discharge planning, is designed to accommodate the specific needs of a geriatric population. ACE unit care takes an interdisciplinary team approach—including a clinical nurse specialist, a geriatrician, a pharmacist, physical and occupational therapists, a primary nurse, a social worker, and a dietitian—that treats the whole patient, rather than the disease-specific approach that works in other service areas and specialties.
The model has become so successful at improving patient care and reducing quality-related costs that Summa has helped dozens of hospitals across the country establish similar units and has hosted more than 90 site visits from healthcare leaders looking to learn more.
"The most significant financial contribution we make to the system is designing and implementing care delivery that maximizes outcomes and controls cost," says Kyle Allen, DO, chief of the division of geriatric medicine and medical director of postacute and senior service at Summa.
ACE units are just one of several new care models focused on improving quality and reducing costs to the overall system through lower mortality rates, ED visits, and length of stay. Though the details may differ, many care models being piloted—whether for acute, long-term, or outpatient care—are based on interdisciplinary, coordinated teams that resemble the medical home concept.
In fact, geriatricians may be the ideal early adopters for medical home models, says Reuben. "If you take a look at elements of the patient-centered medical home and take a geriatrician's practice, they map very closely."
The Centers for Medicare & Medicaid Services is currently testing similar models for possible adoption, including PACE—programs of all-inclusive elderly care—a nursing home diversion program that takes Medicare, Medicaid, and private dollars. MetroHealth partnered with Concordia Care, an independent PACE program in Ohio, to coordinate team-based care out of its centralized Senior Health and Wellness Center.
"The program has been able to dramatically cut utilization of long-term care as well as dramatically decrease the number inpatient days," says Campbell. "That was a very beneficial equation."