Barriers to Medical Home Visits

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 _at_ 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
• Whats 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 lthospitalizations, gt life quality
• Outcome measures for LTCI ltacute, lt
  admin days/costs, ltpt 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 _at_ 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