The CCRC Practice Environment
What a continuing care retirement
community—a planned community for seniors who are
cared for as they age—offers a physician over an
office-based practice is access to a large number of
patients in a compact geographic space. Revenues,
including those that flow to physicians, are derived
from contracts that seniors sign on entering a
community. These contracts guarantee residents
appropriate housing, personal care, and medical
services as their needs change over time.
To qualify for
CCRC entrance, applicants must pass a physical and be
able to live independently when they apply. However,
many stay on waiting lists for years and go directly to
the CCRC’s assisted living on entrance. Unlike
housing-only senior communities or stand-alone assisted
living facilities, CCRCs guarantee care for life. They
can’t evict residents if their health declines or
their money runs out.
Residents pay
entrance fees ranging from $38,000 to $400,000 and
monthly fees from $650 to $3500. Entrance fees vary
according to whether the resident owns or rents his
apartment, the unit size, community amenities, whether
one or two people live there, and the service plan.
Service plans come in three varieties: extensive
(unlimited skilled nursing care with no increase in
monthly fees), modified (specified amount of medical
and nursing services), and fee for service (residents
pay as needed).
A retirement
community’s rationale is that residents’
entrance and service fees guarantee they can move from
independence to assisted living to a skilled nursing
facility as needed. Assisted living support services
include meals, housekeeping, transportation, personal
assistance with ADLs, emergency help, and recreation.
Health services include physician office visits,
nursing services, and medication management.
Physician
involvement and income vary by community. CCRCs include
medical services in their models and support them
financially in several ways. One model is an on-site
office, with administrative, nursing, laboratory, and
marketing help. Matthew Narrett, Erickson Health
Systems’ chief medical officer, points out that
resident service fees subsidize the 40-plus physicians
and 15 nurse practitioners in that system.
Sometimes a medical
practice gets support from a CCRC’s financial and
organizational structure. For instance, the
Massachusetts-based Woburn Medical Associates, a
10-physician group of internists and primary care
physicians, practices at the 50,000-foot Choate Medical
Center on the New Horizons CCRC campus. New Horizons is built on the grounds of Choate
Memorial Hospital, which went bankrupt in 1989. With
$1.1 million in foundation grants and $4 million in
unsecured loans, a non-profit group built New Horizons,
a 120-unit CCRC which charges $2,800 for monthly
independent living fees and $1,502 additional for
assisted living. Many residents use Woburn Medical
Associates physicians at the Choate Medical Center,
which also has orthopaedics, mental health, and
dialysis group practices. g
