Are Treatment Plans Overburdening Older Patients?

As a rehab therapist, you always try to do everything you can to help your patients heal. You craft the right plan of care with the cadence you think best serves a patient's needs. The problem is many of your patients—and particularly older patients—are seeing a handful of different providers and specialists simultaneously, each with their own set of goals and appointments. Given all this, it’s worth asking: are treatment plans overburdening older patients?  

How are treatment plans overburdening older patients?

It’s long been apparent that providers are suffering at the hands of a disjointed healthcare ecosystem, but it’s worth stepping back to look at how some older adults are feeling the pain as well. In the Washington Post article “For seniors, medical care can be a slog, but there are ways to rein it in,” Judith Graham highlights how the current system—increasingly complex and specialized yet largely uncoordinated—is requiring older patients to spend more time trying to get the care they need. In some cases, patients may wait weeks before their initial appointment, and from there, they’re met with a gauntlet of follow-up appointments, transportation concerns, paperwork (from their provider and their insurance), bills, medications, and prescribed lifestyle changes. 

It’s to the point that, according to a study conducted by the Annals of Internal Medicine, patients 65 and older have on average 21 “healthcare contact days” between primary care visits, specialty care visits, testing, imaging, treatment, and procedures. When you add in all the other considerations involved in simply making and keeping those appointments, seniors are spending untold hours (and a fair bit of money) to get the care they need for—somewhat ironically—a better quality of life.     

So what can providers do to ease the burden on seniors? Unfortunately, no magic wand will fix American healthcare—but there are some steps that can help alleviate the problem of treatment plans overburdening older patients.

Create a simpler patient experience—for all preferences. 

Graham’s story points to the use of digital phone systems and patient portals as a complicating factor for older patients. But what happens when a patient has two or three (or even more) patient portals to keep track of? That disjointed ecosystem mentioned earlier suddenly requires the patient to be a tech-savvy navigator of their health and online presence. 

And while WebPT and Clinicient’s Patient Experience Report found that older patients are more receptive to things like appointment reminders via text and digital HEPs, that doesn’t mean that every senior is ready to adopt the digital front door. In addition to offering things like online scheduling and digital patient intake, you should be ready to walk some of your older patients through the use of each one if they’re interested but unfamiliar. You should also hang on to the tried-and-true paper forms and continue taking appointments over the phone; sure, it’s probably a bit more work for all involved, but if it’s easier and more comfortable for some older patients, it’s worth the extra effort.    

Strive for better care coordination. 

While much of the blame for the problem of overburdened patients can be heaped on the broader healthcare system, providers can do better for their own part. How many times have you sat down to start an initial evaluation and asked the patient for a quick past medical history (PMH) only for them to retort, “Shouldn’t you have that information already?” While that’s a fair (albeit grumpy) statement, getting all the regurgitated acronyms and PMH stats is something that can and should be done digitally without bothering the patient. That way, you can focus on the subjective portion of an evaluation. Then the real subjective history can take place—one that focuses on patient-centered care.

To do this, care coordination on the part of a patient’s many providers—facilitated by Direct Secure Messaging (DSM)—can help each better understand the full scope of the patient’s care and deliver necessary information and data without the need for a patient interface. Through better care coordination, providers gain stronger referral relationships and can help save older patients the effort of seeking out specialists on their own. 

Beyond that, the knowledge shared between providers can inform the treatment plan you create for your patient to account for the other demands put on them by the rest of the care team. At a minimum, though, you can ensure a patient’s records are with their next provider when they show up for their appointment.   

Talk to your patients. 

In the Washington Post article, Graham offers patients recommendations on what they can ask their providers in order to understand what’s being asked of them with a given treatment plan and to open a dialog on possibly adjusting that plan. While that’s sound advice, the relationship between patient and provider goes both ways—meaning that providers should take the initiative to have a conversation with patients about their prescribed care.  

You’re probably not aware of treatment plans overburdening older patients—otherwise, you wouldn’t create those plans. Undoubtedly, some patients aren’t comfortable pushing back against what their doctor tells them to do, which puts them at risk of dropout and worse health outcomes. Letting them know you can adjust to suit their needs can serve you well in future communication throughout the episode of care.  

Healthcare professionals can advocate for change.  

Unfortunately, there’s only so much providers can do within the system; to make the big changes that significantly reduce the work involved for older patients (and all patients), it’s going to take policy changes from both the government and insurance companies. Reducing the administrative burden placed on providers would have the downstream effect of decreasing the demands placed on patients—assuming that insurance companies aren’t shifting that burden to patients. That battle starts by investing and leveraging workflows and software platforms that embrace efficiency and build behind-the-scenes processes to reduce that administrative burden (much like WebPT has done with its PXM platform.)

The most evident form of administrative harm that directly affects patients and providers has been the prior authorization game. For too long insurance companies have used prior auths as a means to delay and eventually manipulate patients and providers into not seeking and utilizing the care they need and deserve. According to a study released by the American Medical Association, 94% of physicians have stated that prior authorizations have led to delays in necessary care, and 80% say that patients have abandoned treatment due to authorization challenges with insurance providers. 

In recent months, state attorneys general have begun to roll out lawsuits challenging prior authorization processes in the Medicare Advantage (MA) arena. By removing—or at very least better regulating—how insurance companies use prior authorizations, the burden patients and their providers feel from insurance companies and accessing their health care would be greatly assuaged.

A burden on seniors is a burden on everyone.

Aside from the basic empathy we should all be feeling for our seniors—many of whom are our own grandparents, parents, friends, and other loved ones—we must also be cognizant that we all fall into that category someday. There’s a seemingly endless battle ahead between patients and providers and the many insurance companies. In the meantime, providers can do some of the small things to reduce the burdens seniors face when developing and completing a care plan.