The Patients Are Coming! The Patients Are Coming!

Only HIE Can Handle the Silver Surge

At the risk of spilling yet more ink over one of the most ink drenched generations in American history, it is worth noting how much the baby boomers have affected American life as their presence grew, and how they will also affect American life with their passing. When cohorts of this size come and go once flooded rivers will come to seem like dwindling streams by comparison. Through sheer size, the boomers have transformed everything they have touched. From the cultural shifts of the ‘60s to the development and advancement of the technology world we now live in, they have been a transformational force, for better or worse, which has left a distinctive mark on the way we live. Their numbers have influenced everything and will continue to do so. According to M. Thornhill’s The Boomer Project, nearly 11,000 boomers turn 50 every day — one every eight seconds – and this trend will continue for 19 years. Boomer Marketing News reports that by 2030, there will be more than 65 million Americans over age 65.[1]

And their next venture is healthcare.

Analysts have been “worrying” about the boomer bulge’s effect on the U.S. healthcare system for years, and the chickens are now coming home to roost….and they’ll be roosting for a while. While the first of the cohort turned 65 in 2011, an estimated “65 million boomers will enter the fragmented, underfunded healthcare arena for older people. Today the elderly constitute 12% of the US population and use approximately 35% of all medications. Medication use will likely grow with increased use of multiple medications to treat illnesses and increase longevity. Over the next 20 years, one in every five Americans will be over 65 years of age, and even more important, the 85-plus cohort will expand to 15 million over the next 40 years — about the same length of time that our recent [medical school] graduates will be in practice.”[2]

And while there may be a somewhat comic side to the image of muscled health clubs dominated by oldsters in jogging suits[3], the serious side to all of this is multiple chronic conditions, drug-drug interactions, loss of retirement funds, dementia/Alzheimer’s, diabetes, cardiology and cancer issues, all within the “good news” context of longer lifespans. While aging baby boomers may not be as robust as some would portray, there is also good evidence that the overall burden of disability is declining and there is an increased life expectancy at every age. While demographic data shows the fastest growing segment of the population by percentage is those over 85, the key social trend is the extension of the healthy middle years.[4] Fifty is the new 40, and 70 may well turn out to be the new 50. One thing is for certain, the delivery and cost of healthcare will only increase as boomers continue to age. Even if chronic conditions ramp up more slowly than they have in the past, those conditions will still need treating; and they will surely deteriorate as they always do, if only more slowly. And HIEs and technology are the more flexible solution to the growing and shrinking of patient populations.

What Tools to Battle the Bulge?

So the question becomes: are hospitals, physician practices and communities ready for the coming onslaught? Harbingers of calamity have been riding through the streets of America for decades now crying, “The patients are coming! The patients are coming!” Only slight heed has been given. But to be fair, a large part of the problem has always been … what and where are the tools we will need to deal with this coming tidal wave?

For healthcare providers, the impact will be especially acute. At the same time as boomers were getting older, Medicare had started slashing provider payments. Without congressional intervention, Medicare will slash physician payments about 40 percent over nine years beginning in 2008. This will only result in greater portions of the medical bill falling to the patient and/or the secondary payer. As the aging baby boomer becomes eligible for Medicare, it is imperative for healthcare providers to reassess their technology priorities – and implement some sound business strategies to deal with them as they enter into the hospital revenue stream. Some recent statistics make this issue especially alarming: 1) 80% of Medicare patients have secondary insurance; 2) 30% of secondary claims revenue is never collected; 3) Medicare crossover claims require human intervention 58% of the time. Given the low dollars and high volume in secondary claims, many providers historically have understaffed their organization in this area and simply write them off as bad debt.[5]

In fact, the average healthcare facility today has between 3,000 to 5,000 unresolved secondary claims at any given time. On average the value of each secondary claim is $208, with an average reimbursement rate of $166. With thousands of secondary claims each month, any hospital can experience between $3 and $5 million in secondary claims outstanding. Worse yet, within the past 10 years revenue cycle solutions have receded in importance within hospital IT budgets, replaced by advanced clinical solutions to promote safer and better quality patient care. Rightly so, but the provider industry’s focus on clinical systems has left it ill-equipped, understaffed and budget-strained to counter a phenomenon that can only have a significant negative impact on revenue cycle results if left unchecked.[6] So the cost of high volumes of patients on providers and payers will only increase. It is almost unimaginable how some providers without some form of health information technology, even a rudimentary electronic health record (EHR), will handle the flux and survive, let alone thrive. The final requirements for Stage 2 Meaningful Use will help push physicians toward health technology to handle this impending surge. The volumes of physicians who will be participating in MU2 will help ensure that the flood of boomer patients will be tracked, recorded and appropriately followed improving care and outcomes.

[1] “Baby boomers are coming: is your practice ready?”, News from the American Optometric Association, November 28, 2011
[2] “The Silver Tsunami is Coming: Will Pharmacy Be Swept Away with the Tide?”; Delafuente, Jeffrey C.; American Journal of Pharmaceutical Education 73. 1 (2009)
[3] “Health and Aging Among Baby Boomers”; Blanchette, Patricia; Valcour, Victor G; Generations, Spring 1998; ProQuest
[4] “Health and Aging Among Baby Boomers”; Blanchette, Patricia; Valcour, Victor G; Generations, Spring 1998; ProQuest
[5] “Baby Boomers and Your Technology Strategy”; Sheila Schweitzer, CEO CareMedic Systems; Executive Healthcare; May 2012
[6] “Baby Boomers and Your Technology Strategy”; Sheila Schweitzer, CEO CareMedic Systems; Executive Healthcare; May 2012

John Smith is Director of Communications at ICA. This blog post was first published on ICA’s HITme Blog. John has over 20 years of experience in healthcare communications with a focus on health information technology, having served as Senior Vice President and Healthcare Practice Leader at several communications firms, including Fleishmann Hillard, Manning Selvage and Lee and Brodeur Worldwide.