Multimorbidity, and why it’s difficult to care for complex medical patients

The majority of patients on Medicare have several medical issues to contend with.

For instance, according to this piece in the NY Times, “Two-thirds of people over age 65, and almost three-quarters of people over 80, have multiple chronic health conditions, and 68 percent of Medicare spending goes to people who have five or more chronic diseases.”

And, often times, these patients are seeing anywhere from five to ten different doctors and taking medicines numbering in the double digits.

Caring for these patients is a challenge, and the current medical system is not geared for the influx of baby boomers who are now entering Medicare age.

The pay for performance movement does not encourage doctors to see the whole patient, and in many cases, aiming to meet a single quality measure may interact with other conditions and worsen a patient’s overall health.

Many of the studies that form the basis of future comparative effectiveness research exclude patients with co-morbid conditions, making the findings of such studies non-applicable to this demographic.

Finally, the lack of geriatric and primary care doctors will force these patients to seek more care at the hands of multiple specialists, who only view patients within the narrow spectrum of their field.

To improve the situation, “a major investment in research, guidelines and quality measures that include the kinds of complicated cases doctors see every day,” is needed.

But, as we move forward with health reform, I don’t hear anyone clamoring for a move in this direction.