For those interested in alternative ways to provide geriatrics care, here is a very neat practice that I learned about last month: MemoryCare. (Thanks to Scott Kuhlman of ecpmd.com for the tip.)
Located in Asheville, North Carolina, MemoryCare is a “non-profit charitable corporation, established to meet the rapidly growing need for appropriate assessment, treatment, and support for memory-impaired individuals and their families.”
Similar to my own practice, MemoryCare is consultative and is designed to complement existing primary care. They offer an indepth evaluation, expert assistance on managing dementia, and have a special focus on supporting families and caregivers.
And how is this wonderful service financially feasible for them to provide? MemoryCare has an interesting approach:
- The “clinical portion” is covered by Medicare/Medicaid.
- An additional $495 yearly fee is charged to the caregiver, to cover “supportive care and training of caregivers over a one year period.”
This is a neat way to offer a service that would be financially unsustainable otherwise. As many people know, helping families with dementia concerns is often very difficult within conventional fee-for-service (or even HMO) care, because it is time-consuming and involves no reimbursable procedures. And Medicare doesn’t allow providers to accept Medicare while also charging extra (for those services covered by Medicare).
But by taking a fee from the caregiver, rather than the patient, the clinic is effectively able to charge a patient and family a little extra, for what sounds like a whole lot of needed geriatric expertise and support in coping with dementia. This, according to the website, includes phone support between visits, and one hour follow-up visits.
The fee itself works out to $41.25/month, and the clinic’s website states that they fundraise “so that no family will be denied this service due to inability to pay.”
Unlike my own consultative services, MemoryCare requires a referral from a PCP or neurologist. It’s not clear to me whether this is out of respect for the traditional habit of allowing PCPs to determine what additional care their patients should access, versus necessary to facilitate insurance payment for MemoryCare’s services.
In general, I’d expect that most PCPs in the area would be thrilled to refer to a special service that can help families cope with memory-problems. Still, I would think that more patients and families might access this type of service if no PCP referral were required, although it’s also possible that some families need a PCP’s encouragement in order to seek out (and pay for) this extra care.
I myself am deeply impressed by this model of care, and hope to some day talk to the founders and others involved with the practice. We need more such creative ideas, to better meet the needs of an aging population and their caregivers.
Also, wouldn’t it be nice if Medicare beneficiaries could set aside some of their outpatient Medicare money for discretionary purposes? (I’m thinking of something similar to a small HSA.) They could then choose to spend it on an additional service such as MemoryCare, or perhaps extra assistance at home, or perhaps a geriatric care manager. This would certainly give the patients/consumers a little more influence in shaping Medicare services to their needs, although I suppose we’d have to take steps to protect the beneficiaries from scammers out to siphon off their discretionary funds.
Hm. We must keep collectively thinking about all this. The status quo is certainly not sufficient.
For a more scholarly description of MemoryCare’s practice, there is a nice short article in the Alzheimer’s & Dementia journal here.
Have you come across any other interesting models for providing — and financing — geriatric care? Post a comment or drop me a line.
