This article was originally posted on McKnights Homecare. Read the full article here.
In the face of a growing physician shortage, older adults are less likely to find the care they need. Today, the number of primary care physicians is growing, but not fast enough to keep pace with aging Americans who will soon account for 42% of the demand for primary care physicians. By 2034, the U.S. is projected to experience a shortage of 48,000 doctors.
To stem this troubling tide, we need innovative solutions that support both primary care physicians and their aging patients.
After serving as a primary care physician and hospitalist for over 35 years, I’ve witnessed the challenges that physicians face in keeping up with the needs of our rapidly aging population. Even in the early days of my career, I found myself juggling up to 30 patient appointments per day. Since many of my older patients had complex medical needs, the standard 20-minute appointment barely provided enough time to delve into their detailed medication regimens, let alone the multiple chronic conditions and other health care concerns they were managing.
Looking back, I wish I had known then what I know now. There was (and is) a senior care program — the Medicare and Medicaid Program of All-Inclusive Senior Care for the Elderly (PACE) — in my community that could have helped both me and my patients. Established in 1974, PACE is a provider-led, community-based care model that delivers crucial at-home and in-center services to low-income seniors, providing an important alternative for many to nursing home care.
After hearing about this model, I devoted a few hours to the program each week before joining full-time in 2017. The past seven years have been the most satisfying of my physician career — and here’s why.
- Interdisciplinary care: While physicians play a crucial role in guiding participants’ care plans, the PACE model embraces team-based care to alleviate the burden on a single primary care physician. Through the interdisciplinary care model, PACE participants have access to a team of health care professionals, including nurses, home care coordinators, pharmacists and social workers, in addition to their primary care provider. This holistic approach ensures that team members can operate within their own scope of practice, identify a participant’s needs, and work with the interdisciplinary team on a coordinated response.
- Serving the underserved: The PACE program offers high-quality care to those who don’t always receive it in our current healthcare system. Eighty percent of PACE participants are dually eligible beneficiaries, receiving coverage from both Medicare and Medicaid. PACE is unique in that Medicare and Medicaid financing covers all services under this provider-led, community-based model — meaning that participants don’t have to worry about any deductibles, co-pays, or out-of-pocket expenses. This makes a critical difference for low-income participants like those we serve at my program in Erie, PA, who would otherwise have to decide between paying for their medication or keeping their heat on through the winter.
- Autonomy: By design, PACE cost-effectively addresses the needs of populations with high rates of chronic illness, including the dually eligible and rural populations my program serves. This is, in part, because PACE operates like a managed care organization, allowing the care team to avoid regulatory burdens plaguing other systems like prior authorizations and instead quickly authorize the services and procedures appropriate for each participant.
With the physician shortage rapidly worsening, it’s crucial that healthcare professionals support each other to reduce burnout and continue providing quality care to our nation’s older adults. I urge primary care physicians and other healthcare professionals who have frail, low-income patients to consider referring them to a PACE program. The PACE model is a proven resource that can efficiently meet participant’s care needs while easing the burden on primary care physicians who simply don’t have the time to fully meet the needs of their frail, vulnerable older patients.
PACE is an important way that communities can help alleviate their physician shortage while bridging the gap in our nation’s senior care infrastructure to meet the health care needs of our aging population more adequately.
Kevin Shaffer, MD, serves as the medical director at LIFE-NWPA, a provider of PACE services in Northwest Pennsylvania.