Instead,itwasjustgeriatrics.Thegeriatricteamsweren’t
doing lung biopsies or back surgery or insertion of
automatic defrailers. What they did was to simplify
medications.Theysawthatarthritiswascontrolled.They
madesuretoenailsweretrimmedandmealsweresquare.
Theylookedforworrisomesignsofisolationandhada
social worker check that the patient’s home was safe.
Howdowerewardthiskindofwork?ChadBoult,the
geriatrician who was the lead investigator of the
University of Minnesota study, can tell you. A few
monthsafterhepublishedtheresults,demonstratinghow
muchbetterpeople’sliveswerewithspecializedgeriatric
care, the university closed the division of geriatrics.
“Theuniversitysaidthatitsimplycouldnotsustainthe
financial losses,”Boultsaid from Baltimore, where he
hadmovedtojointheJohnsHopkinsBloombergSchool
of Public Health. On average, in Boult’s study, the
geriatric services cost the hospital $1,350 more per
personthanthesavingstheyproduced,andMedicare,the
insurer forthe elderly,does not coverthatcost. It’s a
strangedoublestandard.No oneinsists thata $25,000
pacemaker or a coronary-artery stent save money for
insurers. It just has to maybe do people some good.
Meanwhile, the twenty-plus members of the proven
geriatricsteamattheUniversityofMinnesotahadtofind
newjobs.Scoresofmedical centersacrossthecountry
have shrunk or closed their geriatrics units. Many of
Boult’s colleagues no longer advertise their geriatric
trainingforfearthatthey’llgettoomanyelderlypatients.
“Economically, it has become too difficult,” Boult said.