This proposal is for a conference on the appropriateness of third-party methods of payment for geriatric health services, principally involving the physician in primary care settings. The conference objectives are (1) to assess the state of knowledge about how typical payment methods influence the care of geriatric patients, (2) to formulate issues and identify questions requiring further study, and (3) to determine what innovative payment approaches or reforms might be tested and evaluated for consequences to cost and quality-of-care factors specific for the geriatric patient. Medical and related services for geriatric patients follow patterns different from those for younger patients. More physician time is required for history taking, multiple diagnoses, care planning, counseling, and monitoring the physical, mental and social factors in chronic illness in the aged. Also different are the resources a physician, physician extender, and geriatric nurse-practitioner must call upon to carry out a plan of care. However, physician payment is based on patterns of acute care, geared to procedurea (particularly instrumental technologies), and conditioned historically by needs of job-based insurance packages, hardly reflecting the special needs of the aged. Little support is provided for the """"""""team approach"""""""" in geriatrics, based on a physician-nurse-social worker core. Given the growing elderly population and costs of care, it is useful to raise the questions: Are medical payment methods employed by most third-party payers in conflict with good geriatric practice? Do they hinder the application of new knowledge and insight concerning proper care of the aged? Do they obstruct advantages obtainable through the team approach? What solutions appear feasible? At what cost? The conference will be sponsored by the Ritter Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York City. Conferees will include: (1) private health insurers, (2) public payers, (3) policy specialists from the Congress and State government, (4) physicians in private practice and academic medicine, (5) other professions, particularly physician extenders and geriatric nurse-practitioners, and (6) Federal agencies, such as the National Center for Health Services Research and the Health Care Financing Administration. Some 60 conferees are expected. The meeting agenda will promote discussion and probe for possible consensuses. Preparation will include a study of practitioner-encountered problems related to payment.
