Clinical laboratories will need new methods for accommodating the increase in senior patients seeking rapid access to medical laboratory testing and pathology services
Experts within the healthcare industry are predicting existing care delivery models will need to be revised within the next few years to accommodate a rapidly aging population dubbed a “silver tsunami.” Many hospital systems are actively taking steps to prepare for this coming sharp increase in the number of senior citizens needing healthcare services, including clinical laboratory testing.
Multi-hospital health systems will have to accommodate demand for healthcare delivered in ways that meet the changing expectations of seniors. These include rapid access to clinical laboratory testing and anatomic pathology services, electronic health records, and telehealth visits with their doctors.
These trends will also require clinical laboratories to evolve in ways consistent with meeting both the volume of services/testing and improved levels of personal, speedy access to test results that seniors expect.
All of this is problematic given the current state of hospital staff shortages across the nation.
Investopedia defines the term “silver tsunami” as “the demographic shift caused by the increasing number of older adults in society, led by the baby boom generation.”
Baby boomers are individuals who were born between 1946 and 1964. The US Census Bureau estimates there are 76.4 million baby boomers living in the country today, and that by 2030 all boomers will be 65 years of age or older.
“In the next five years, the most significant disruptor to healthcare will be the capacity challenges associated with the ‘silver tsunami’ of baby boomers hitting the age of healthcare consumption,” said Jonathan Washko, MBA, FACPE, NRP, AEMD (above), director at large, National Association of Emergency Medical Technicians (NAEMT) and assistant vice president, CEMS Operations, in an interview with Becker’s Hospital Review. Clinical laboratories will have to engage with these senior patients in new ways that fit their lifestyles. (Photo copyright: EMS1.)
Silver Tsunami Could Transform Healthcare
Approximately 10,000 people turn 65 in the US every day, making them eligible for Medicare. This increase in recipients is likely to strain the government system. Healthcare organizations are seeking new ways to prepare for the anticipated boost in seniors requiring health services.
Washko believes the population shift will cause healthcare leaders to develop novel care models based on “intelligent and intentional design for better outcomes, lower costs, and faster results,” Becker’s Hospital Review reported.
“Solutions will require shifts to care in the home, new operational care models, and technology integration,” Washko noted. “These will allow the medicine being delivered to be effectively and efficiently optimized, vastly improving the productivity of existing and net new capacity.”
A recent HealthStream blog post outlined some of the methods hospitals can use to adapt to an aging population. They include:
Facility Design: Modifying lighting, using large-print signage, providing reading glasses and hearing amplifiers, purchasing taller chairs with arms and lower examination tables.
Technology: Offering assistive devices, creating more telehealth options, developing more user-friendly websites and electronic medical records.
Healthcare Delivery: Training staff on geriatric care, offering services intended for an older population, such as geriatric psychology, fall prevention programs, and establishing a more patient-centered environment.
“Anticipated regulatory challenges post-election will influence healthcare operations. The looming recession may alter how individuals access healthcare and treatment based on affordability,” Shelly Schorer, CFO CommonSpirit Health, told Becker’s Hospital Review. “Despite these headwinds and challenges, at CommonSpirit we are prepared to pivot and meet the changing needs of our communities by accurately predicting and addressing their healthcare needs efficiently.”
“This represents the greatest market disruption on the near-horizon,” said Ryan Nicholas, MD, Chief Quality Officer at Mercy Medical Group. “This has prompted Mercy Medical Group to move rapidly into value-based care with focus on total cost of care and network integrity.”
Nichols told Becker’s Hospital Review that Mercy’s Medicare population has increased by 24% over the last year, and that Mercy is anticipating a growth of 28% over the next year. These increases have convinced the organization to shift its view of service functions and to invest in additional resources that meet the growing demands for senior healthcare.
“Expanding ambulatory services and improving access for primary care services to reduce unnecessary [emergency department] utilization and shorten length of stay is our top priority,” Nichols said.
Shifting Demand for Clinical Laboratory Testing
This is not the first time Dark Daily has covered how shifting demographics are changing the landscape of healthcare services in nations where populations are aging faster than babies are being born.
Thus, many healthcare organizations are taking a proactive approach to the expected increase in seniors needing care for age-related and chronic illnesses.
“This along with other risk and value-based models will continue to drive integration of healthcare services and the value proposition through improving quality while reducing costs,” Alon Weizer, MD, chief medical officer and senior vice president, Mount Sinai Medical Center, Miami Beach, Fla., told Becker’s Hospital Review. “While we are investing heavily to be successful in these models through primary care expansion and technology that will help reduce the need for acute care services, we continue to focus our culture on providing safe and high quality care to our patients.”
Clinical laboratories will need to adapt to the changing needs of older patients to ensure all people receive high quality care. The coming “silver tsunami” will require labs to evolve in ways consistent with meeting the growing needs of seniors and providing better levels of personal services and access to cost-effective, fast, and accurate lab testing.
Demand for low cost, convenient access to doctors and drugs is driving transformation to decentralized medical care, and retail pharmacy chains see opportunity in offering primary care services
Retail pharmacies and pharmacists continue to play a growing role in healthcare as consumer demand for lower cost and convenience pushes the nation’s medical landscape away from centralized healthcare systems. Clinical laboratories have seen this in the increasing trend of consumers seeking vaccinations and home-health tests at their local drug stores.
Results of a pair of surveys dubbed “Pharmacy Next” conducted by Wolters Kluwer Health revealed that 58% of people are now willing to be treated for non-emergency healthcare conditions in non-traditional medical environments, such as retail pharmacies and clinics.
This is a finding that clinical laboratory managers and pathologists should incorporate into their labs’ strategic planning. It portends a shift in care away from the traditional primary care clinic—typically located in the campus around the community hospital—and toward retail pharmacies. Labs will want to capture the test referrals originating from the primary care clinics located in retail pharmacies.
This willingness to access medical care in non-traditional environments is especially true among people in Generation Y (Millennials) and Generation Z (Zoomers)—people born between 1981-1996 (Gen Y) and 1997-2012 (Gen Z), according to Journey Matters.
“As we saw in last year’s survey, primary care decentralization is continuing—the traditional one doctor-one patient, single point of coordination is vanishing, and this is especially evident in younger generations,” said Peter Bonis, MD, Wolters Kluwer’s Chief Medical Officer, in a press release.
The online surveys of more than 2,000 US adults was weighted by age, gender, household income, and education to be representative of the entire population of the United States.
“By preparing for this shift today, providers can work in concert across care sites to deliver the best care to patients,” said Peter Bonis, MD, Wolters Kluwer Health Chief Medical Officer, in a press release. “Likewise, newer care delivery models, like retail pharmacies and clinics, can ensure they’re ready to meet the expectations of healthcare consumers, who will increasingly be turning to them for a growing range of care needs.” Clinical laboratories may find new revenue opportunities working with the primary care clinics operating within local retail pharmacists and clinicians. (Photo copyright: Wolters Kluwer.)
Key Findings of the Wolters Kluwer Pharmacy Next Studies
Some key insights of the surveys include:
Care is rapidly decentralizing with 58% stating they are likely to visit a local pharmacy for non-emergency medical care.
Younger generations are signaling lasting change within the industry as they are more open to non-traditional styles of care.
61% of respondents envision most primary care services being provided at pharmacies, retail clinics, or pharmacy clinics within the next five years. Of the respondents, 70% of Millennials, 66% of Gen Z, 65% of Gen X, and 43% of Baby Boomers believe this transition will occur.
Consumers are worried about prescription costs and availability.
92% of respondents said physicians and pharmacists should inform patients of generic options.
59% of surveyed consumers have concerns about drug tampering and theft when it involves mail order or subscription prescription services.
One in three respondents believe convenience is more important than credentials in non-emergency situations.
The survey indicates that healthcare consumers across multiple generations are open to a shift in some medical services from doctors to pharmacists. However, there were some notable differences between generations.
Respondents of the Baby Boomer (55%) and Gen X (57%) generations stated they would trust a physician assistant with medication prescriptions, while only 42% of Gen Z and 47% of Millennial respondents felt the same way.
Additionally, Boomers (57%) and Gen X (67%) said they would feel comfortable with a nurse practitioner issuing their prescriptions, while only 44% of Gen Z and 53% of Millennials said they would.
Increased Comfort with Genetic Testing at Pharmacies
The surveys also showed that younger generations are more open to the field of pharmacogenomics, which combines pharmacology and genomics to analyze how an individual’s genetic makeup (aka, heredity) affects the efficacy and reactions to certain drugs. This is a key component of precision medicine.
Overall, 68% of individuals polled believe their individual genomic data could guide prescription decisions, with Millennials (77%) and Gen Z (74%) being the primary believers. Additionally, 88% of respondents stated they see an incentive for health insurers to cover genomic testing, and 72% said they would be open to genetic testing for personalized medical care.
But pharmacists and clinicians should be aware that advancing pharmacogenomics will require addressing privacy concerns. According to the Wolters Kluwer study, 57% of Gen Z and 53% of Millennials have apprehension surrounding genetic testing due to privacy risks, with 35% of Gen X and Boomers holding that same opinion.
Healthcare Staff Shortages, Drug Cost a Concern
Survey respondents are also concerned about pharmacy staff shortages and expenditures when seeking care at a pharmacy. Half of the participants are worried they will receive the wrong medication, half worry about getting the incorrect dosage, and almost half (47%) fear receiving the wrong directions due to overburdened pharmacy employees.
More people in Gen Z (59%) and Millennials (60%) had these concerns compared to Gen X (44%) and Boomers (38%).
Sadly, a distressing 44% of those surveyed admitted to not filling a prescription due to the costs. That number jumps to a staggering 56% among individuals with no health insurance, compared to 42% for insured patients.
“From hospitals to doctors’ offices, from pharmacies to pharma and beyond, healthcare must move to more affordable and accessible primary care models, adopt innovations that help deliver more personalized care, and address persistent safety and cost concerns that consumers have about their medications,” said Bonis in the press release.
Can Pharmacies Deliver Primary Care as Well as Doctor’s Offices?
Pharmacies may be logical setting for at least some non-emergency health services. According to the Centers for Disease Control and Prevention (CDC), approximately 90% of the US population live within five miles of a pharmacy and about 72% of visits to physician’s offices involve the prescribing and monitoring of medication therapies.
“We’re not talking about complicated services. We’re talking low-acuity, very basic care,” said Anita Patel, PharmD, Vice President of Pharmacy Services Development for Walgreens, at the HIMSS conference.
Pharmacies across the country continue to add more healthcare services to their available public offerings. This trend will likely persist into the future as healthcare becomes more expensive, wait times for physician appointments increases, and medical staff shortages rise. Thus, there may be opportunities for clinical laboratories to support pharmacists and doctors working in retail settings.
It’s not just radiology. Gen Z residents will be matching in pathology and other specialties, and that means clinical laboratories should be ready to adapt their recruiting and training to Gen Z’s unique characteristics
It’s a big event in medical schools across the nation when it is time for residency programs to match residency candidates with first-year and second-year post-graduate training positions. But this year has a special twist because—for example in radiology—this is the first class of Generation Z (Gen Z) residency candidates to be matched with radiology residency programs.
In their abstract, the authors wrote, “This year, the radiology community will experience the beginning of a generational change by matching its first class of Generation Z residents. To best welcome and embrace the changing face of the radiology workforce, this Viewpoint highlights the values that this next generation will bring, how radiologists can improve the way they teach the next generation, and the positive impact that Generation Z will have on the specialty and the way radiologists care for patients.”
Members of Gen Z are now entering the workforce in large numbers. To recruit high-quality candidates from this generation, healthcare employers—including clinical laboratories and pathology practices—may have to adapt the way they interact with and train these individuals.
Gen Z is generally described as individuals who were born between 1995 and 2012. Also known as “Zoomers,” the demographic comprises approximately 25% of the current population of the United States. They are extremely diverse, tend to be very socially conscious, and can easily adapt to rapid changes in communications and education, according to the AJR paper.
Although the paper deals with radiology, this type of information can also be valuable to clinical laboratories as Gen Z pathologists are poised to enter clinical practice in growing numbers. This marks the beginning of the professional laboratory careers of Zoomers, while Millennials move up into higher levels of lab management, the oldest Gen Xers near retirement age, and Baby Boomers retire out of the profession.
“Gen Z employees bring unique values, expectations, and perspectives to their jobs,” said Paul McDonald (above), Senior Executive Director at staffing firm Robert Half in a news release. “They’ve grown up in economically turbulent times, and many of their characteristics and motivations reflect that.” Thus, clinical laboratories may have to develop methods for recruiting and training Gen Z staff that match the unique characteristics of Gen Z candidates. (Photo copyright: LinkedIn.)
Zoomers Like Digital and Artificial Intelligence Technology
One of the most unique aspects of Gen Z is that they have never lived in a world without the Internet and have little memory of life without smartphones. Zoomers grew up totally immersed in digital technology and tend to be comfortable using digital tools in their everyday life and in the workplace. They lean towards being very open to artificial intelligence (AI) and how it can assist humans in analysis and diagnostic methods.
“This group of professionals has grown up with technology available to them around the clock and is accustomed to constant learning,” said Paul McDonald, Senior Executive Director at staffing firm Robert Half in a news release. “Companies with a solid understanding of this generation’s values and preferences will be well prepared to create work environments that attract a new generation of employees and maximize their potential.”
According to the AJR paper, Zoomers learn best by doing, so employers should concentrate on interactive learning opportunities, such as simulations, virtual reality, and case-based methods for teaching the aspects of the job. They are likely to expect digital and blended resources as well as traditional approaches to learning their new job responsibilities.
The paper goes on to state that Gen Z members value diversity, equity, inclusivity, sustainability, civic engagement, and organizational transparency. Their social consciousness and diversity may yield a greater range of perspectives and problem-solving approaches which may bolster their sensitivity to patient-centered care.
“The oldest in Gen Z have already seen a recession and a war on terrorism. They’ve seen politics at its worst. And now they’ve seen a global pandemic and are about to see recession again,” said David Stillman, founder of GenGuru, a boutique management consulting firm that provides insights on how best to connect with Baby Boomers, Generation X, Millennials, and Gen Z, in an interview with the Society for Human Resource Management (SHRM). “They are survivors,” he added.
According to the SHRM, “Stillman says Millennials, who preceded Generation Z, were coddled by their parents. He maintains that Generation Z’s parents were more truthful, telling their offspring, ‘You’re going to have a really tough time out there, you have to work super hard,’ which he says created ‘the most competitive generation in the workforce since the Baby Boomers.’”
Gen Z Wants More than a Paycheck, They Want Purpose
The American Journal of Roentgenology paper also states that Gen Z members grew up in a rapidly changing world and tend to be resilient, adaptable, and flexible. They have experienced and witnessed many stressors and navigate these issues by focusing on mental health and a meaningful work-life balance. With respect to a profession, they are searching for more than just a paycheck, and they want a purposeful career where they feel a sense of belonging.
Increase information sharing and transparency to help alleviate fear and anxiety.
Incentivize them by showing them clear paths to career progression.
Make sure they know how their individual contributions matter to the organization.
Motivate them by giving them room for autonomy and experimentation.
Provide specific and constructive feedback.
Harness community and in-person interactions to boost professional collaborations.
Prioritize wellness and mental health.
“Be prepared to spend time with them face to face,” McDonald stated. “They want to be mentored and coached. If you coach them, you’re going to retain them.”
Preparing to Attract Gen Z to Clinical Laboratories
As Generation Z comes of age, more of them will be working in the medical professions. Clinical laboratories and anatomic pathology groups would be well advised to prepare their businesses by adjusting leadership, adapting recruiting efforts, and shifting marketing to attract Zoomers and remain relevant and successful in the future.
Although sweeping statements about individual generations may be limiting, understanding their unique insights, values, and backgrounds can be helpful in the workplace. With a large amount of Gen Z workers now transitioning from college into careers, it will be beneficial for clinical laboratory managers to recognize their unique characteristics to recruit and maintain talented workers more effectively.
Either way, if Medicare is allowed to run dry, millions of patients (most among the elderly) may be unable to receive critical care, including clinical laboratory testing and pathology.
“The Hospital Insurance (HI) Trust Fund, or Medicare Part A, which helps pay for services such as inpatient hospital care, will be able to pay scheduled benefits until 2028, two years later than reported last year. At that time, the fund’s reserves will become depleted,” the 2022 Medicare Trustees Report states, which draws its data from a US Treasury Department fact sheet.
“The progressively worse imbalance of expenditures versus revenues will exhaust the trust funds in 2028,” Weems wrote, adding that one of two payment scenarios will likely happen:
Medicare may pay bills on a “discounted basis,” which means if expected revenues are 85% of expenditures, then Medicare would pay bills at 85% of the amount, or
Medicare may put bills aside until it has the money from tax dollars.
“And then (Medicare would) pay them on a first-in-first-out basis,” Weems wrote, adding, “At the time of insolvency, that current Administration would have to pick its poison.”
For hospital clinical laboratory leaders and pathologists who provide care to Medicare beneficiaries, neither approach would be satisfactory. And a solution for funding Medicare Part A beyond 2028 needs to be crafted to ensure hospitals are paid on a timely basis.
But what should it be?
“Medicare’s two-part insurance and trust fund design may have made sense in the mid-1960s, but it no longer does. Modern coverage is not bifurcated in this way and imposing stricter financial control over facility spending than clinician and outpatient services can distort the policy-making process, and thus also patient care,” wrote James Capretta (above), Senior Fellow at the American Enterprise Institute, in his analysis of the 2022 Medicare trustees report, published in Health Affairs. If Medicare truly does run out of money, millions of elderly people may lose access to critical healthcare services, including clinical laboratory testing. (Photo copyright: American Enterprise Institute.)
Medicare Funding Scheme is ‘Flawed’
According to the Kaiser Family Foundation (KFF), the amount of money Medicare needs to cover the deficit between 2028 through 2031 (the period studied in the trustees’ projections), is estimated at $247.4 billion.
Medicare is supported by employers and employees, who each pay a 1.45% tax on earnings, KFF explained. Balancing the fund supporting Medicare Part A requires either an increase of .70% of taxable payroll or a 15% reduction in benefits, KFF estimated.
“Medicare will not cease to operate if assets are fully depleted, because revenue will continue flowing into the fund from payroll taxes and other sources,” KFF noted.
However, the current set-up of Medicare trust funds (one for Part A and another funded differently for Medicare Part B, which includes outpatient coverage such as medical laboratory tests), is “flawed” and needs updating to enable reform.
Furthermore, Medicare faces challenges brought on by an aging population and increasing enrollees.
Baby Boomers (born between 1946 and 1964) will qualify for Medicare by 2030 and potentially leave the workforce, depleting their payroll tax contributions to the program, KFF pointed out.
Also, Medicare reform needs to reflect the impact of the COVID-19 pandemic. An analysis of 114,000 COVID-19-associated deaths from May to August 2020 showed 78% of the people were age 65 and older, according to the federal Centers for Disease Control and Prevention (CDC).
“Medicare beneficiaries whose deaths were identified as related to COVID-19 had costs that were much higher than the average Medicare beneficiary prior to the onset of the pandemic,” the 2022 Medicare Trustees report noted.
“The surviving Medicare population had lower morbidity, on average, reducing costs by an estimated 1.5% in 2020 and 2.9% in 2021. This morbidity effect is expected to continue over the next few years but is assumed to decrease over time before ending in 2028.”
In his 4Sight Health article, Weems suggested that the Medicare reform deadline was bumped to 2028 from 2026 due to fewer people living and able to access Medicare in coming years.
“Let’s honor those seniors by using the time for real Medicare reform,” Weems wrote.
Hospital laboratory managers and pathologists will want to keep a watchful eye on Congress’ handling of the 2022 Medicare Trustees Report. Though it is unlikely the nation’s decision-makers will act on the report during an election year, pressure to develop a solution to meet the funding needs of Medicare Part A hospital care beyond 2028 will start to build in 2023.
Medical laboratories can get ahead of the trend by developing processes for serving younger healthcare consumers in different ways
Experts say that Millennials are rewriting the rules of healthcare. Rather than following in baby boomers’ footsteps, this new generation of young adults shops for healthcare in ways that may change the provider-patient relationship for all providers, including pathologists and medical laboratories.
Also known as Gen Y, this generation interacts with healthcare providers differently than earlier generations in at least three basic ways:
When seeking medical advice, they first turn to websites;
They prefer to ask friends for physician referrals; and,
They are not shy about requesting discounts from providers to cut their medical costs.
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