Senior Wellness – Staying In Front of the Tidal Wave of Healthcare Expenses
by Brian Hazelgren
Addressing Unnecessary Costs Associated With Senior Care
The senior population in America is growing at an alarming rate. The Centers for Medicare & Medicaid Services (CMS) estimate that there are over 10,000 retirees coming on to the Medicare platform every day. You read that right…every DAY. This number – coupled with an average spend of $38,000 in the last six months of life, prompted Medicare to come up with another way to engage the seniors more often with their physicians. In 2010 the senior population on medicare saw approximately 14% of all medicare patients with 6 or more chronic conditions. In only a few short years, that number has risen to 18% of the Medicare patient base.
Too many seniors were going to the ER to be treated for things like a simple cold, a sprained ankle, urinary tract infection, and other illnesses that were non-emergency services. The reason they were ending up in the ER was due to that fact that it was more convenient to just show up at the ER – than to schedule an appointment with their primary care physician – and then have to wait a few days to get into see the doctor. The patients simple felt that Medicare would cover the expenses, and most of them had a supplement to cover the 20% copay.
Obviously there are legitimate reasons for seniors to go to the ER, like stroke, heart attack, adverse drug reactions, injuries and accidents, etc., but the previously mentioned symptoms do not represent the most valid reasons.
Enter in CPT code 99490. In January 2015 Medicare released a new code for physicians to receive reimbursement if the medicare patient had 2 chronic conditions, and a medical clinician representing their practice would spend at least 20 minutes of time with the senior patient on the phone during a 30 day period. Seemed like a great idea at the time, but it was slow to be adopted by the physicians.
There are about 55 million patients on Medicare in the US, and of these approx. 40 million have two or more chronic conditions.
Recently the US Senate passed a new bill to improve the outlook for patients with chronic conditions. They passed the bill unanimously because they too see the benefit of engaging the senior population more often – instead of every couple of years – and then have high costs to provide healthcare through an emergency room situation. The Finance Committee for Chronic Care Working Group reintroduced the Chronic Care Act of 2017 to address some of these issues regarding senior care. It is a bipartisan bill to strengthen and improve health outcomes for Medicare beneficiaries living with chronic conditions.
“Improving care for seniors with chronic conditions is one of the most important things Congress can do to modernize the Medicare program for the 21st century,” Sen. Mark Warner (D-Va) said. “These are bipartisan, data-driven policies developed after two years of careful study that will improve access and care for these high-need patients, and ensure that Medicare can provide high-quality care for seniors today and in the future.”
Today there are over 58,000 senior care facilities in the US. There are over 1.2 million patients who reside at these senior care facilities, with a bed population of 1.4 million. So, we need to ask ourselves if there are approximately 55 million Medicare patients and only 1.4 million beds available, along with an average of 10,000 people each and every day coming on to the Medicare platform, will there be enough services available for our seniors? What if the chronic conditions continue to rise, how will an over-burdened system be able to help these patients – our loved ones – find better patient care?
“Medicare shouldn’t just be a program that pays the bills when you get sick,” said Sen. Johnny Isakson (R-Ga). “It should also encourage your doctors to work with you to keep you healthy and out of the hospital by providing high quality, patient-centered care. I’m proud to once again introduce this legislation that will help promote better-coordinated care for seniors with multiple chronic health conditions while also empowering doctors and patients to work together to improve the overall health.”
These are a few steps in the right direction towards providing better health care for seniors. What it does is allow payments to be made from Medicare for services rendered to seniors.
Generating New Streams of Income for Senior Care Centers
In 2016 I was presenting our Workplace Wellness program to the executive team of a senior care services company with 2,000 employees. Halfway through the presentation I was stopped by the chief legal counsel who asked a great question: “Can you modify your wellness program to work for our seniors in our centers?” The question kind of caught me off guard for a moment – because I was there to speak with them about Workplace Wellness for their 2,000 employees – and then the thought popped into my mind, “Yes, I believe we can come up with some modification of our program to aid seniors.”
My next question seemed logical to ask why they wanted to discuss a program for the their patients, instead of their employees, and the answer was simple. I quickly learned that this particular senior care company was experiencing a patient turnover of about 3 patients per month – from every one of their 312 facilities. I then asked why the patients turnover so frequently, and it came down to three things: 1) the patients pass away; 2) the family runs out of money; and 3) the patients hate being in the facility and want to go home. We agreed that I probably couldn’t help them with the first two reason’s but that we could definitely come up with something to help them with the patients wanting to leave the facility. I soon realized we had some work to do to help figure out a program that would work for the senior care centers to drive additional revenue, and help them provide better patient care.
We began working on the types of services that senior care centers could offer their patient base, and still get paid for those services. I soon uncovered a gold mine: there are certain CPT codes and G Codes that Medicare will pay for that fall under a “wellness program.” So I tailored a package of services and products that will be highly beneficial to the patients, and would be covered by Medicare. Today, we offer these services to senior care centers to help them grow their business, and to provide better patient care.
The services and products that we offer are a combination of therapy, cognitive and physical exercises that can be performed individually, or in a group setting. We also add in a component to include family, and that opens up even more ways to receive reimbursement from Medicare.
A quick look at the services that we came up with include the following areas of assistance for senior patients:
- Telehealth or Telemedicine
- Brain Boost Games
- Chatting With a Friend
- Armchair Yoga
- Senior Circuit Step
- Core Strength Exercises
- Upper Respiratory and GI Panel
- DNA and PGX Testing
- Thermal Imaging
- Weight Loss Program
Significant Income Streams
The income generated by a senior care facility can be significant as we are able to drive more revenue – and cut down on expenses. We are also able to offer services and products that are highly needed in providing better overall patient care. For example, if a center has three patients that leave the facility every month, it means lost revenue to the tune of about $3,500 per month – per patient. If we are able to keep one patient in the facility for three more months, and provide a few extra services, it is worth having a discussion and taking a look at additional revenue streams.
Each patient represents about $4,800 per month in new income (including the new services), so if we are successful in keeping one patient, three more months, it means about $14,400 in extra revenue to the senior center – per patient. In the case of the senior care company that I originally presented to, it would turn into an extra $4.5 million in new income.
The cost is minimal to implement a program for a senior center, and the services are provided by a medical clinician. The services billed to Medicare are associated with specific CPT and G codes that Medicare reimburses for. Each exchange is different, and the contracted rate will apply for a local market, but it is definitely worth the time and effort to have a discussion of how to improve patient care, and create new streams of income to support the overall growth of the senior centers.
There are currently 1.4 million beds to house 55 million potential patients in senior centers. That is 2.5% market penetration – and it is woefully low – especially since the chronic conditions will most likely continue to increase in our senior population. Now is the time to address the coming tidal wave of chronically ill seniors in a system not equipped to handle a sudden influx of millions of new patients!
Now is the time to get the services and programs lined up for the centers to take advantage of as they meet two critical needs: 1) more seniors will be coming into the system; and 2) additional revenue streams for the care centers. I used to think there were too many senior care facilities popping up everywhere, and that was a big mistake on my part. There is plenty of market space available for many more centers to be built. When they are built, and when the seniors to enter the facilities, we are ready to serve them and provide additional services and products sorely needed.
In good health!
Brian is the Master Franchisee of Arizona for RX2Live, and his Arizona based company is known as Platinum Partners Wellness. You can see all of the services provided by his company at www.platinumpartnerswellness.com Brian can also be reached at firstname.lastname@example.org.