A portion of the Texas Health Harris Methodist Fort Worth emergency-department expansion underscores the importance of giving special attention to geriatric patients.
The hospital broke ground recently on a new three-story, 75,000-square-foot ED, one block south of its current facility. The facility, which will connect to the main hospital through a skybridge, is expected to open December 2013. It will be three times larger than its current ED and have 90 beds—a 50 percent increase.
The ED facility will also include a geriatric care clinic for follow-up care, addresses two pressing needs: the growing number of elderly ED patients and the fact that fewer Texas primary-care physicians are treating new patients.
Nearly 25 percent of ED visitors are elderly, according to the Centers for Disease Control. The growth of those aged 65 and older has outpaced other age groups. By 2030, one out of five Americans will be in that age group, and nearly one out of four Medicare recipients will be age 85 or older.
Nearly six out of 10 Americans age 75 or older visited the ED at least once in 2002, compared with fewer than one out of four for all age groups. Elderly patients arrive with more medically complex conditions that require longer care and more diagnostic tests, generating more expensive ED bills. Their ED use has risen even as use by other age groups has decreased.
Dr. Mark Rosenberg is chief of geriatric emergency medicine at St. Joseph’s Medical Center in Paterson, N.J., and is chairman of the American College of Emergency Medicine’s geriatric section. He predicts that at least 25 percent of U.S. hospitals will have geriatric ED facilities in the near future.
Satisfying patients and ensuring they do not return to the ED has always been good hospital business practice. Under health reform, not doing these things could seriously erode a hospital’s margin.
Beginning in October, Medicare payments will be tied to scores on patient satisfaction surveys and how often patients are readmitted to the hospital. Low-performing hospitals will be penalized for excessive ED readmissions and hospital-acquired infections. Conversely, hospitals can earn bonus payments based on how well they follow 12 clinical care measures and how patients rate their care experiences.
Just as baby boomers are becoming elderly, fewer doctors are treating them. According to a recent Texas Medical Association survey, 58 percent of the state’s physicians will take new Medicare patients, compared with 78 percent in 2000.
Lillie Biggins, president of Texas Health Harris Methodist Fort Worth, said the clinic would fill that primary-care gap. “Some of our (geriatric) patients can’t see a doctor because they don’t take Medicare patients, or they can’t get an appointment for a month,” she said. “This is a way for us for to focus on what happens next (after the ED visit).”
What are the elderly doing now without the clinic?
“They’re using the ED for primary care. And that’s risky, very risky,” Biggins said.
The clinic will be staffed by a geriatrician and two nurse practitioners who specialize in caring for the elderly, she said. It will be equipped to do lab work and X-rays, and will include a classroom to teach patients and their caregivers how to manage chronic conditions and practice good health habits.
The clinic expects to treat about three dozen patients a day.
Biggins said the hospital also is focusing on post-acute care to minimize readmissions. She said the hospital has met with more than 50 organizations to determine whether they can meet their care standards.
In July, Texas Health Resources announced it was forming a joint venture with Methodist Health System and LHC Group of Lafayette, La., to deliver home health care to patients.
The new ED includes some treatment rooms that are more geriatric friendly, such as offering thicker mattresses and better lighting. Biggins said about 25-30 percent of the hospital’s ED patients—and about 40 percent of all patients—are elderly.
“Sometimes the elderly kind of get pushed to the side,” she said. “Our clinic will be wheelchair-accessible. The decor will have warm tones. We want to make it nice for the family. We want them to feel invited.”
Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected]