If you are a regular reader of The Fischer Report, you are well aware of the dramatic effect the Baby Boomer generation is having on the health care system. As Boomers who work in the health care industry retire, the workforce is struggling to keep up with the increasing demand those same Baby Boomers are putting on the system.
The survey studied the shrinking number of potential small business buyers compared to the number of retiring business owners. It showed a dramatic decrease in the potential buyers that could put the squeeze on Boomers who are trying to profit from a life’s work.
Looking ahead between 2015 and 2025, we estimate that over 19,000 business owners will want to retire, with fewer than 23,000 new owners to take their places. Put differently, the ratio of willing buyers to willing sellers will fall from 1.6 in recent years to 1.2 in the years to come.
The report goes on to illustrate the effects this could have on retiring Baby Boomer business owners that could put a serious damper on retirement plans.
This will likely have one of two effects: it will encourage the prospective sellers to work longer, or it will force those sellers to accept lower sale prices for their companies. At times, it will have both effects. Prospective sellers may work longer than they want hoping for a better price that never comes and ultimately sell at a discount anyway.
If you think this is a problem for Connecticut think again. The report compared the Baby Boomer dilemma in the Nutmeg State to the nation and found the effect intensifies.
Nationally, we are on the verge of an even more pronounced change in the ratio of older business owners looking to sell vs. younger adults that might consider buying businesses. As shown in Exhibit 6, this ratio ranged from 1.34 to 2.05 from 1950 through 2000. This means that, in the second half of the 20th century, there were substantially more prospective “buyers” than “sellers.” It is a different story in the 21st century, as this ratio is projected to be just slightly over 1:1 from 2015 onward.
Yet another illustration of how the Baby Boomer generation will challenge our systems as our country prepares to help the largest generation enjoy their golden years. We must innovate to meet demand and control cost. Failing to do so could be a greater threat to our national success then any other influence.
Baby Boomers are retiring at a startling rates and their need for long-term care at home is causing the health care industry a host of problems. The biggest of which is a shrinking workforce especially among home health aides.
The problem of finding people to work as home health aides involves a number of factors. These jobs are often low paying with some working for as low as $8.50 an hour without benefits. It’s a shockingly low rate of pay considering the amount of responsibility a home health aide has. In fact most those who use long-term care services in their home depend on home health aides for everything from basic household chores to medically necessary treatment needed on a daily basis. In the case of the frail elderly the lack of care could have dire consequences.
Take for example an Elderly Lady in Ithaca, New York who according to the local newspaper had to go to the hospital because she lacked the home care support she needed.
An elderly, wheelchair-bound Tompkins County woman says she was left for almost two months without the home care aide she needs.
Lane Woods, 68, of Trumansburg says this isn’t the first time this has happened. A six-week stint without an aide when she lived in Niagara County ended with her being sent to the ICU due to the strains of caring for herself and maintaining her home without assistance.
The paper goes on to site several local officials who blame the shortage of home health aide workers for the limited access to home care services.
What is playing out in New York is happening all over the country as baby boomers and their children struggle to met the challenges left by increasing health care demands. The elderly often depend on home health aides to provide care when family or friends are at work. The shortage leaves many of the frail elderly to fend for themselves at home often with disastrous results.
Adding to the problem of low pay is the breakneck increase in demand for home based services. According to a 2013 report by the U.S. Bureau of Labor Statistics, Personal Care Aides, Home Health Aides and Nursing Assistants are job categories projected to see an over 48% increase in job openings by 2022. Those three segments combined, all of which are employed by the home care industry, will make up the nations second largest workforce with 4.8 million laborers by 2022. Only the retail workforce is larger.
Government Still Part of the Problem
Now before you start beating the drum for government mandated pay increases you should consider that increasing the hourly rate is only part of the problem. During 2015 various states around the country have begun mandating wage increases for home care workers. A good first step but only half the problem.
In an effort to keep up with the increased cost of health care delivery, Medicare and Medicaid have been making deep cuts in reimbursement over the last five years. The most recent is scheduled to take place in 2016 and will slash $350 million from the Medicare budget. The latest cost saving measure by the government adds to the $60 million in cuts that took effect just this year. Medicaid has seen similar cuts in recent years although those vary by state.
That leaves home care companies struggling to find away to deal with pay rate mandates while receiving less in reimbursement.
Lack of Coverage
Medicare only covers short-term home health care based on acute need often of only an hour or two a day for duration of 60 days. But what happens to the frail elderly who need services for longer than Medicare based insurance coverage can provide. Those patients are often left without access to the care needed to help them age in pace at home. Rather the lack of care often ends like our lady from New York with a trip to the hospital and possibly a nursing home.
For patient to receive long-term home health care they often have to pay out-of-pocket or depend on local aging services agencies to provide subsidized care (often funded by Medicaid). But decreasing reimbursements and program cuts make access to care provided through these agencies difficult at best with most having to spend time on a waiting list before funding is available.
Fixing the Problem
Such a complex problem requires a dynamic solution. Policymakers and health care industry leaders must come together and develop ways to provide access to quality care for those who need it most our frail elderly. Of course cost will be a factor which means compromises both government agencies and the health care industry will have to make sacrifices. The home health care industry will have to accept some additional regulations in order to combat fraud and waste and the government will have to increase its efficiency in processing and reimbursing claims.
The Fischer Report will not just present a problem without a solution. That is why we are starting a series of articles called Fixing Home Health Care where we will spotlight ways the public and private sectors are working together to solve the health care crisis for our seniors and forward new ideas that could help in the future. Hopefully it generates the discussion about how we can better care for our elderly.
Necessity is the mother of invention they say. But in the case of the Baby Boomer generations it is also the mother of innovation. The nations largest generation is demanding more convince and efficiency from their health care providers and providers are responding with more creative use of technology.
The latest innovation is coming from the field of Telemedicine when patients and doctors are using technology to increase communication and avoid unnecessary cost.
Telemedicine is not a new concept. The method of communicating a patients health status remotely through the telephone has been around for about a decade. One of the earliest pioneers in telemedicine was Philips who developed the Lifeline system as an emergency alert system for the frail elderly. Lifeline later developed automated medication reminder/dispensing systems as well as ways to communicate vitals remotely to a patients primary physicians office.
Now the game is changing again as home-based health care services like visiting physicians and home care companies are utilizing telemedicine to communicate more effectively with patients. A recent article in US News written Dr. Vik Bakhru, CEO of First Opinion a mobile health company in San Francisco, says his company is using both new and existing technology to improve communication with their patients.
The implications for telemedicine are far-reaching, and have the potential to completely transform the health care industry for the better. Take for instance those unnecessary doctor visits, which are easily the biggest contributor to the long waiting room times and short doctor/patient face time. Too often, these visits are simply to determine if an ailment actually needs the attention of a doctor.
When the answer is no, it is a completely wasted trip. But if a patient is simply wondering if a skin irritation is minor or symptomatic of a more serious condition, having the ability to text message a doctor or text a photo of the affected area to a physician to get an informed opinion on next steps could be a major time saver – not to mention that it gives the patient peace of mind, faster. By streamlining that first contact, the whole industry will begin to see positive effects as less time and money is wasted in the waiting room.
Dr. Bakhru goes on to say “What we need is a bridge between efficiency and efficacy, between cost-effectiveness and quality of care.”
The industry is in desperate need of cost saving measures as the number of retired American’s grows at a record pace. Telemedicine could be the method that can finally cut some of the waste in the health care system without sacrificing quality.
The forward thinking folks at First Opinion aren’t the only medical professionals using technology to get better outcomes for patients. Some home care companies are including emergency alert systems like Lifeline as part of their service to better respond to their patients needs. Traditional doctors offices are also turning to things like web cams to check on patients at home.
For those family members who are trying to care for an elderly parent while holding down a full-time job, telemedicine can help keep them in connect with key members of the health care team.
Tell us your story, have you successfully used telemedicine technology as a caregiver. We would love to hear from you. Leave a comment below or send an email to AnthonyFischer@elderadvocacygroup.info.
There Is More Technological Innovation Coming To Healthcare
Just as healthcare systems are fully implementing electronic medical records, even more technological innovation is coming to healthcare. But instead of targeting providers these innovations will be available directly to consumers.
So who is driving the new innovation inspiration? Google of course. For those who have tracked Google lately this is no surprise. Google recently founded a holding company called Alphabet. That company has declared war on Diabetes, naming the disease as an area of focus.
Don’t expect Alphabet, a spin off of Google X, to stop at Diabetes. An investment bank Cowen and Company has tracked Google and thinks the tech giant could be on the verge of making major investments in new healthcare innovations.
A recent report by the investment bank says: “A closer look at Google’s vast health care efforts,” the report says, “reveals that the company is targeting very large markets with an expansive list of projects that with even minor success could justify the company’s recent investments.”
An article by Mark Bergen of re/code.net, a tech blog focusing on dot coms, cites Google’s major investments in companies focused on telemedicine, dermatology and Diabetes.
With the new influx of money into healthcare research and development, Google hopes it can add a spark to the industries normally slow pace. Picking up that pace would be advised as the healthcare industry prepares for the enormous and expensive challenge of caring for the retiring Baby Boomer generation.
Healthcare systems, who are already struggling with a shrinking workforce and lack of licensed professionals, are looking for any way to provide quality care at a lower cost. Medicare and other third-party insurers would also welcome innovations that allow patients to receive lower cost care at home.
They say necessity is the mother of invention. That cliché is more true today than it has ever been as the nation tries to avoid a potential healthcare crisis caused by a title wave of aging Baby Boomers.
Michigan Lags Behind Other States In Home Care Regulation
Home Care services will play a key role in the ever-changing healthcare system. With an avalanche of Baby Boomers nearing retirement age, the healthcare system is desperate for services that provide quality care cost efficiently while keeping patients from making costly emergency room visits.
Baby Boomers are also demanding more innovation and service improvements in healthcare just as they have of every other service they have consumed. Skilled Home Care, Hospice and Telemedicine have proliferated as a result. So much so that lawmakers and policy wonks in Washington are expecting a dramatic increase in Home Care utilization over the next decade.
So what’s holding the rapidly growing home care industry back? Fraud. New companies have sprung forth to meet demand with many founders having little to no experience in healthcare service delivery. Without the proper expertise to compete by providing quality service, owners turn to fraudulent schemes to make ends meet.
As a deterrent to fraudulent behavior the FBI has made a public spectacle of Medicare fraud busts. The FBI press releases have had their intended effect but they have also had the unintended consequence of deterring patients form using the service. That combined with the reluctance of doctors to refer to potentially fraudulent providers has slowed the development of this much needed service.
Most states have faced the fraud problem head-on by requiring companies to apply for a state license in addition to the federal Medicare license. The extra requirements have served as their own deterrent to Medicare fraud.
Still there are four states in the union that don’t require any additional licensing to operate a home care company. Michigan, Ohio, Iowa and Massachusetts all refrain from further regulating the home care industry. To their credit Ohio and Massachusetts require additional licensing for the professionals that work in the industry. However Michigan Home Care Companies remain the least regulated and companies in the state remain a major target of the FBI’s Medicare fraud task force.
The increase in fraud could have something to do how easily an entrepreneur can open a home care agency in Michigan. Even with little to no knowledge of the healthcare system. Potential owners can also obtain a license to operate a home care at a relatively small cost. Normally expensive costs like labor can be purchased cheaply through contractual agreements with payment deferred until after the operator receives the license.
This year the federal agency overseeing Medicare and Medicaid reimbursement (CMS) finally issued a moratorium on new home care licenses. However the move comes after many fraudulent companies are already in operation in Michigan.
Another factor contributing to fraud is the infrequency of home care regulation provided in the current system. Federal Medicare regulations require that licensed home care agencies be inspected
every two years. The Centers for Medicare and Medicaid Services (CMS) depend on third-party regulators to facilitate the survey process. Organizations like the Community Health Accreditation Partner (also known as CHAP) and the Joint Commission provide professionals to conducting inspections. Although all inspectors receive training a shortage of inspectors often puts the process behind schedule.
The gap between inspections (known in the industry as surveys) opens a window of non-compliance with agencies able to ignore regulations without fear of inspection. During this time agencies often go without key staff like Qualified Administrators, Clinical Directors, Medical Directors and key office staff to cut overhead cost and squeeze more profit out of the bottom line. This practice adversely effects care and lowers the inter-agency accountability. Without key healthcare professionals taking an active part in the company, owners often cut corners and open the door for fraud.
Not A Small Problem
The fraud problem isn’t limited to small companies or start-up companies. Large companies with years of experience have also fallen into fraudulent habits either through malicious intent or negligent.
More regulation, especially in Michigan can help stem the tide of fraudulent behavior. Additional state licensing, requiring licensed administrators and an increase in inspection frequency can help fix a horribly flawed system. For now consumers should make themselves aware of the warning signs of Medicare fraud as well as asking their lawmakers to increase home care regulations.
The cost efficiency of home care service can go along way to saving the healthcare system. Until fraud is rooted out however the American taxpayers will have to foot the bill for billions of dollars in increased healthcare cost.