Prodded by Congress, Medicare will tie more of its compensation for doctors and hospitals to the quality of their care. And who, you might ask, could be against such pay for performance--besides incompetent providers trying to preserve their reimbursements? Doesn’t it make sense to pay docs and hospitals for improving the health of their patients rather than for the volume [...]
Discharge planning is often a broken link in the chain of care for hospital patients. Older adults and others with complex care needs nearly always need follow-up after they are discharged. They’ll almost certainly have to take new medications. They may need bandages changed after surgery, or physical therapy after a stroke. Unfortunately, they and their families rarely get the [...]
Older adults are getting too much medical treatment. No, I am not suggesting we ration treatment for seniors or empower the mythical death panels. Rather, the health system should replace aggressive but ultimately useless medical interventions with more care. This means rethinking the way we care for older adults with chronic disease. We should organize care around the goal of improving their quality of life rather than on [...]
Cancer researchers are closer than ever to achieving their long-held dream of turning the disease from a death sentence to a chronic illness. This would be a remarkable scientific achievement. But while people may soon routinely live decades with their cancer in remission or even cured, they will not become immortal. Most will eventually suffer from some other debilitating condition and [...]
In a recent essay in The Washington Post, geriatrician and author Jerald Winakur described the recent hospital experience of his 91-year-old mother. You won’t be surprised to learn it was a nightmare: Poor pain management, overworked staff, insufficient training, little communication among physicians and no communication between his mom and the waves of medical professionals who treated her each day. [...]
Want to know what’s wrong with the health care system for older adults in the US? It can be summed up in that 10-word response on a physician’s voice mail. One evening last month, I got a panicked call from a friend: She came home from work and discovered that her widowed mother, who has been living with her for [...]
We spend more on our health care as we age. No news there. But you may be surprised to learn that all health spending is not created equal. For most of us, as long as we can stay out of the hospital or a nursing home, our costs are relatively modest--and steady--even as we grow older. But that can change [...]
Ask a physician why he prescribes unnecessary tests or treatments, and he’s likely to say he’s responding to demands from his patients (or trying to avoid a lawsuit). But a new study in the journal JAMA Oncology finds that perception may be wildly wrong. The study, by Keerthi Gogineni, Katherine L. Shuman, Derek Chinn, Nicole B. Gabler, and Ezekiel Emanuel [...]
If you are 65 or older and living in America, your chances of getting Ebola are vanishingly small. You are far more likely to contract—and die from—everyday infectious diseases such as flu, a variety of stomach viruses, or common bacteria such as C. difficile (c. dif.) and methicillin-resistant Staphylococcus aureus (MRSA). These common infectious diseases are responsible for one-third of [...]
When we think about the health of frail older adults, severe, high-profile illnesses such as dementia, heart disease, cancer, and debilitating arthritis come to mind. But for many seniors, small things can turn a manageable chronic condition into an acute medical crisis. One is malnutrition. Spend a little time in a hospital emergency department and you’ll be shocked at how [...]