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Barriers to Medical Home Visits

Barriers to Medical Home Visits. Martie Lynch, BS, PA-C, Physician Assistant, Internal Medicine/Geriatrics November 10, 2004. Physician Assistants : Where Do We Fit In?. Mid-level (extender) services & scope of practice in CA Credentialing Reimbursement Medicare provider (IPN)

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Barriers to Medical Home Visits

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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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