Healthcare is changing. It is going to continue to be molded and reshaped over a long period of time to pursue better quality with reduced costs. The Institute of Medicine (IOM) report, “Crossing the Quality Chasm: A New Health System for the 21st Century” lead the call for healthcare reform in 2001. Many other organizations like the Institute of Healthcare Improvement (IHI) have followed with their Triple Aim framework: Better Care, Better Health, Lower Costs.
We know the value that home health brings to the table with much lower costs. We also know that there is a lot of room for improvement as an industry, and many agencies are working very hard to provide better care in more cost-effective ways. Unfortunately, home health is sometimes limited by inflexible regulations.
Dr. Steven Landers, a national home health supporter, recently authored an article in the September 26, 2013 online version of the Journal of Medical Association (JAMA) entitled, “The Future of Medicare Home Health Program.” He explains what the current Medicare Home Health benefit is today including eligibility requirements; bundled payments; budget cuts for 2014-2017; agency margins; patient satisfaction scores; and readmission rates. This provided foundational information for physicians who may not be as knowledgeable about home health services.
Next, Dr. Landers discusses the opportunities for improving the value of home health through the Affordable Care Act (ACA). This includes home health’s participation in many different programs such as independence at home programs; accountable care organizations; bundled payments; patient-centered medical homes; and readmission reduction initiatives. These programs incentivize physicians and hospitals to partner with home health agencies to reduce avoidable hospitalizations and other inpatient admissions. Dr. Landers does look at the limitations with these projects for home health related to the current regulations that do not always allow the flexibility for newer models of care.
Other areas Dr. Landers addresses are related to better alignment of payment with value; “bridging” (care transitions) early in inpatient settings; role changes for medical directors be more active as they are in hospice benefit; and role changes for advance practice nurses and physician assistants. Fraud and abuse need to be aggressively addressed, and telemedicine expansion should also be pursued.
Many – if not most – of Dr. Landers’ vision for home health mirror that of many agencies across the country. Read the full free article for more insights.
Landers, S., (2013). The Future of Medicare Home Health Program. JAMA. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1742539