Longevity Center Aims to Provide Better Healthcare, not More Healthcare
David Lipschitz, MD, says that the country’s healthcare providers cannot afford to practice medicine the way they currently do and continue to serve the country’s aging population. And he doesn’t think that lawmakers in Washington have the answer.
But, with the Longevity Center at St. Vincent, he thinks he might.
“We really hope that the model we’re developing here will eventually be able to revolutionize medicine,” he said. “We think we have the solution to America’s healthcare problem.”
Lipschitz, a leader in the field of geriatric medicine, has been developing the Longevity Center since July 2008. It differs from other approaches in a number of ways, starting with its target population. Instead of waiting for patients to reach what many would consider old age, its goal is to start working with them at age 50 to prepare and educate them for a longer, healthier life.
“It’s never too early or too late to pay attention to your health,” he said. “The more we focus on 50-year-olds, the greater the chance that those 50-year-olds will be independent when they’re 80.”
The Longevity Center has nine physicians, but Lipschitz’s goal is to see that number increase to 50 so that 50,000 patients are seen on campus while creating a new paradigm that is adopted by other providers. The relationship starts with an initial evaluation – ideally when the patients turn 50 or even before. Lipschitz says the process is not dissimilar to what goes on at places like the Mayo Clinic and the Princeton Longevity Center, except that those programs employ a battery of high-tech tests that he says are neither necessary nor affordable on a large scale. In contrast, the Longevity Center employs only those tests recommended by major medical societies and preventive care groups.
“What we want to do is create a preventive program for the common man so everybody will have access to it,” he said.
A key element of the process is what Lipschitz calls couple care. According to Lipschitz, the woman in the home makes 85-90 percent of the family’s healthcare decisions, so he likes for couples to come in for appointments together, though they can be seen by separate physicians. Unmarried patients should bring a friend, partner or relative, he said.
This first visit is a doozy. After an initial evaluation, patients receive extensive counseling on nutrition, visit with a stress management counselor, and are evaluated by an exercise physiologist. Lipschitz is hoping this first visit initially will be covered by insurance, but until then those who can pay are charged $200 while those who can’t are charged nothing.
A healthy 50-year-old won’t visit the Longevity Center again for another year unless it is necessary and will receive yearly checkups until about age 60, when the frequency will begin to increase. Those visits will be longer than the traditional visit. Lipschitz said the typical doctor at the Longevity Center sees 12-20 patients a day, far below the industry average.
Health education and communication are keys to the Longevity Center’s approach. A hotline and doctors’ cell phone numbers and email addresses are made available to patients, and the center is developing web-based communication tools to keep in touch with patients.
The goal is not to control costs but to provide better, more appropriate care, which Lipschitz said will have the effect of controlling costs. The preventive care will help patients remain healthier longer and keep them out of hospitals. Meanwhile, Lipschitz said doctors at the center will explain to patients the advantages and disadvantages of potential procedures.
Those that have not been demonstrated to be beneficial will not be encouraged. “But on the other hand, the goal should not be to do less, but to do right,” he said. “There’s a huge difference between doing less and doing right, and that’s what I’m interested in.”
The clinic aims to provide as many services as possible in-house, including care for acute and chronic conditions, but it does refer patients to outside specialists such as those at the Arkansas Neuroscience Institute, the St. Vincent Memory Center, and the St. Vincent Diabetes and Endocrinology Center.
Nidhi Jain, MD, is an endocrinologist at the St. Vincent Diabetes and Endocrinology Center, which sees many of the Longevity Center’s diabetes patients. She said that the Longevity Center’s approach does help her manage her own patients’ care because of the communication advantages it offers and because of the resources available there.
“The team approach at the Longevity (Center) does help our patients too who come to us from them,” she said. “Because if I’m worried that I’m starting some patient on this new medicine and I want to make sure that the patient does OK, I can always call on the social worker at the Longevity (Center) and arrange for some sort of follow-up at home.”
So how will providers who adopt Lipschitz’s less-is-more philosophy continue to make a profit in a system where the financial incentives are to provide more care, not necessarily better care? Lipschitz said one way is by serving more patients who are attracted to this kind of medicine. Another is by enjoying the downstream effects of serving more geriatric patients. Lipschitz acknowledges that the clinic itself loses money and must be subsidized by the hospital system. But he said that geriatric patients ultimately make the hospital money. Research he did a number of years ago while developing a geriatric program at UAMS indicated that for every $1 generated at the clinic, $18 will be generated for the system by providing other services.
“One of the lessons we’ve learned is that we have to persuade the leadership of healthcare throughout the country that taking care of older people and providing ambulatory primary care for them is highly cost-effective and valuable to the entire facility. …” he said. “It requires a lot of time. It requires a lot of effort. It is slow. It requires a critical mass of physicians before you can begin. And the more doctors that you have, the more the expenses, the more concern the leadership has that you’re not really bringing in sufficient revenue. So it takes time, and people have to understand the incredible potential value of delivering the highest possible primary care to a large group of adults.”
Lipschitz believes the recent healthcare reforms enacted in Washington changed insurance but not healthcare. Real healthcare reform must be physician-led, he said, or the consequences will be disastrous as the baby boomer population ages. The good news is, it can be done.
“We’re not doing rocket science here,” he said. “We’re being very simple. We want to practice the right medicine. That’s all.”
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