I’ve already written about hospice and
tele-monitoring. Home care is the
obvious third leg of the non-acute care stool.
For patients that are at home, and can’t get anywhere else, providing
care to them in their home is significantly more attractive to them and to
whoever has to pay the total bill than having them go without care, get worse, and
finally need a visit to the emergency room.
Medicare alone spent 78 Billion Dollars on home care in 2012. It’s a big business. But is certainly is not being used to the
fullest. It is interesting to note that
although there is a lot of discussion these days about our payment systems
evolving from fee-for-service to some sort of Outcomes Based Reimbursement,
home care under medicare has been operating that way since 2001. The system is called PPS (prospective payment
system) and basically gives home care agencies a flat amount for a 60 day
episode of care. The amount of that payment
is determined by the answers to an assessment (OASIS) designed to determine how
difficult that patient will be to care for.
Home care has made this system work for them for over a
decade now. Providing good care to
people in their homes has avoided some hospitalizations, and has allowed some
patient to stay in their home, rather than have to move to a facility.
Traditionally, health care systems have not put much
emphasis on home care. Even hospitals
that own home care agencies frequently don’t have a good handle on how that
business works. In the past, with
separate payments, hospital visits avoided by home care did not necessarily
benefit the bottom line. Going forward,
they will. That means large health care organizations that don't own or affiliate closely with a home care agency will have higher costs.
Like so much of what needs to happen in health care, the need to use home care more is just plain old common sense. Let's hope health entities begin to catch on to that.
