"Now everyone has to make sure he hasn't injured himself, so he gets a head CT and an X-ray of his hip. That drives up costs. He's getting all these extra tests because he got a drug that would have worked fine in a 45-year old, but didn't in a 75-year-old with cognitive impairment.
"If he'd come to the ACE unit we would have given him Zofran instead," which wouldn't have prompted his confusion and loss of balance, Flood says. That's one way ACE units save money.
An emerging issue for Pierluissi, however, is that the proliferation of ACE units means each hospital is adopting their own version of the program, so it's hard to know which components works.
"Is it the pharmacist, or the person who pushed the patient to walk every day? If I have a limited amount of money and don't want to do the whole thing, what is it that really matters? It's hard to tease out what is the secret sauce."
"We don't know." There's no accreditation organization for ACE units. That will change, especially as healthcare reform penalties and incentive payments kick in at higher rates in coming years.
"All of the folks who have looked at the economics carefully show that it pencils out, and even more so in a setting of healthcare reform," Pierluicci says.
So why don't more hospitals have them?