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Overcoming Barriers to Medical Home Visits: Enhancing Care Access and Quality

Explore the challenges and solutions in conducting effective medical home visits, covering topics such as reimbursement, cultural resistance, cost analysis, and the role of care managers post-physician team visits.

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Overcoming Barriers to Medical Home Visits: Enhancing Care Access and Quality

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  1. Barriers to Medical Home Visits Martie Lynch, BS, PA-C, Physician Assistant, Internal Medicine/Geriatrics November 10, 2004

  2. Physician Assistants : Where Do We Fit In? • Mid-level (extender) services & scope of practice in CA • Credentialing • Reimbursement • Medicare provider (IPN) • “Incident to” billing (SNF & rehab) • Medical malpractice liability coverage • My background

  3. Barriers to Home Care • CMS Review Committee (current & past claims) • Home care: most scrutinized, denied, and inappropriately compared to cohort groups (with example) • Cultural & generational resistance • American Academy of Home Care Physicians • Top leadership: George Taler, and Gresham Bayne, Ed Ratner, MDs • Goals: inititate changes to Medicare law for geriatric residencies & reimbursement for home care

  4. Cost of Care: ER vs. Home Care • 80% ER visits by 75yo+ unnecessary* • ER ave=___; HC ave=____ • Incentive for local docs: reimbursement (15% higher for home care) • Portability & miniaturization of technology allow full services of urgent care at home • UTIs, CHF, Pneumonia • 24/7 free home pharmacy delivery • Affordable ambulance transport for hospitalization when necessary

  5. “The Healing Arts” • End of Life @ 2 years • Re-infuse aging process w/respect & dignity • MDs in home grow to leave behind the “business” of health care & embrace the healing arts • MD becomes guest • Consumer has locus of control • What’s in it for the clinic doc?

  6. LTCIP & Medical Home Visits • Disease Management Model vs. Population Health Model • DM has patient seek ambulatory care programs • Superimpose DM w/multiple chronic and functional conditions • PHM transfers responsibility from pt. to doc: results in <hospitalizations, > life quality • Outcome measures for LTCI: <acute, < admin days/costs, <pt & family distress • LTCI to support medical home visits • Membership to AAHCP? • Support for needed policy changes

  7. Medical Home Visits as SNF Alternative • Consumer and caregiver choice • EOL in own environment: safely & comfortably dying @ home • Cost of EOL care in hospital vs home • Quality of EOL care in hospital vs home • #1 Marketing tool: “What your customers tell their friends about you”

  8. What Comes After the Physician Team at Home • The “pass-off” from MD team to care manager • Why MD team does not do care management • Provider of Care Management: Cyndi Hasz

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