1 / 18

Home Visits: Family Doctoring Outside the Clinic

Home Visits: Family Doctoring Outside the Clinic. Carla Ainsworth, MD, MPH October 25, 2011. Goals of this talk. Clarify the RRC expectation of home visits in residency Discuss the “nuts and bolts” – what do I need to do a good home visit?

gerard
Download Presentation

Home Visits: Family Doctoring Outside the Clinic

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Home Visits: Family Doctoring Outside the Clinic Carla Ainsworth, MD, MPH October 25, 2011

  2. Goals of this talk • Clarify the RRC expectation of home visits in residency • Discuss the “nuts and bolts” – what do I need to do a good home visit? • Can I do home visits in practice? A bit about the finances of home visits in primary care

  3. Why do home visits? • More convenient for the patient • Patient is too sick to get to the clinic • Patient mobility makes transport difficult • No one can accompany the patient to visit • Opportunity to see the patient in context • Change of scenery for the provider • Opportunity to change the pace of productivity expectations

  4. Who is a good candidate? • Acute illness • Hospice patient dying at home • Home assessment • Unable to get to clinic • Failing at home for unclear reasons • Chaotic social situation • Follow up hospitalization

  5. Home visits in residency • “Each resident must perform at least two home visits with at least one being for an older adult continuity patient” • ‘Faculty must supervise either on site or by prompt chart review as is appropriate”

  6. This sounds great. How do I set it up? • Call patient and let them know you would like to see them at home • Ask if there is a friend or family member they would like to have present • Let them know about how long you think the visit will last • Confirm address and ask about directions or parking • Call to confirm that you are coming the day before

  7. What to bring • Stethoscope • Documentation – computer with Epic? • Consider bringing: • Blood pressure cuff • Otoscope • Monofilament • Forms that pt/family can send back (POLST, advance directive) • Supplies for labs, vaccines, procedures?

  8. Assessment - INHOMESSS • Impairments/immobility • Nutrition • Home environment • Other people • Medications • Examination • Safety • Spiritual Health • Services

  9. Medication review • Ask to see the meds at home • Where/how are they stored? • Are there extra bottles/expired meds around? • Does someone help with organizing or administering?

  10. Ask about mobility within the home • Your own home safety evaluation • Entryways • Stairs • Rugs, low chairs, overall visibility • How would your patient get out in an emergency?

  11. Remember this feels significant to patients – a true “house call” • Be respectful • Be gracious – patients and family will often try and feed you • Take a moment to learn something about them that you would never know from seeing them in clinic • Family pictures • Where your patient spends his/her time • How things are set up for her to succeed (or not succeed) at home

  12. A moment about personal safety • Think about where you are going • Don’t go in if it doesn’t feel good to you • Think about taking someone with you • Let someone know where you are going

  13. Can I afford to do home visits in practice? • Home visits reimburse slightly better than clinic visits • Clinic visits • 99213 -- $179 • 99214 -- $266 • Home visits • 99348 (low complexity) -- $211 • 99349 (mod complexity) -- $312

  14. Different settings, different reimbursement • Patients live in lots of different settings, reimbursement varies: • Home services – visit in a private residence • Domiciliary, Rest Home, or Custodial Care services – assisted living and adult family homes • Reimbursement is slightly higher • Nursing home care – in a certified long-term care facility

  15. Medicare rules for “home-bound” Medicare patients have to be “home-bound” to be eligible for home health services. A patient qualifies if: • Leaving home isn’t recommended because of medical condition • Patient’s condition keeps her from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person) • Leaving home takes a “considerable and taxing effort”

  16. It’s okay to go to church • Patients may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. • Attending adult day care does not disqualify a patient from home health services

  17. Care Plan Oversight Services • Don’t have to see the patient! • Review of home health agency plan of care, labs, phone calls to other members of the health care team, family members, and adjustment of treatment plan • Can bill for this once within a 30 day period • Not if they are in the nursing home • Not if there is no adjustment to their plan

  18. Additional resources • American Academy of Home Care Physicians • www.aahcp.org • Centers for Medicare & Medicaid Services • www.cms.hhs.gov

More Related