The Future of Home Health Care Workshop Summary (2015) / Chapter Skim
Currently Skimming:
4 Key Issues and Trends
4 Key Issues and Trends
Pages 35-48
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From page 35... ...
This chapter describes three presentations that explored overarching trends currently being seen and how they may affect planning for the future role of home health care. Trends in Population Health Tricia Neuman Kaiser Family Foundation Home Health Care Under Medicare and Medicaid In home health care, the typical silos of Medicare and Medicaid do occasionally interact and overlap, but they are not truly integrated, affirmed Neuman.
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From page 36... ...
Fifteen state Medicaid programs allow recipients to arrange their own services, including providing payment to family caregivers. These self-directed services programs have generally proved successful in reducing unmet patient needs and improving health outcomes, quality of life, and recipient satisfaction at a cost comparable to that of traditional home health agency–directed service programs.
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Total Medicaid spending includes both state and federal spending. Home health care includes medical care provided in the home by freestanding home health agencies.
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These are people with multiple challenges." Although most of these challenges arise in the context of aging, they also face the population of people with disabilities covered by Medicare. Neuman presented data indicating that home health care usage overall, the number of home health care visits per user, and Medicare spending per user all rise with age, as does the use of many other health care services, including inpatient care, skilled nursing care, and physician services, and the use of some drugs (but not hospice care)
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Effects of Policy Changes Neuman stated that policy changes can spur innovations affecting home health care. These innovations are often aimed at the integration of systems of acute care and LTSS for dually eligible individuals and the development of team-based geriatric care.
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From page 40... ...
Keeping frail elders with chronic diseases and disabilities out of acute care could save a lot of money, so "the opportunity at the front end to really solve the Medicare cost problem is a serious one." Research also suggests that home health care can play a substantial cost-saving role in post-acute care as well. To take advantage of such opportunities, the home health care sector will be required to document not just their cost savings but also the quality of the care that they provide.
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Limitations in the Design of the Medicare Home Health Care Benefit for Today's Population Most people are unaware of home health care services until a moment of crisis, when a staff member from the hospital, inpatient rehabilitation center, or nursing home advises them that their loved one is being discharged and arrangements for care in the home need to be made, McCann said. Thousands of Medicare beneficiaries who are older or have disabilities and their families have had to face this crisis and are receiving home health care, but the benefit is a poor fit to their needs, McCann said.
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Data Shortfalls McCann said that many health care data exist but that almost no information on home health care is available. Since 2000, whenever a Medicare or a Medicaid patient has received skilled care, nursing services, or therapy at home, providers have had to collect more than 100 pieces of
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From page 43... ...
For example, physicians assess pain differently than do physical therapists, and physical therapists assess pain differently than do home health agency personnel, she said. Nor do these three groups assess dependence in ADLs in the same way, making it more difficult to assess change or improvement.
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From page 44... ...
She said, "We need to get more evidence about how well those systems are working for seriously impaired people before we think that managed care and capitation will be a solution for care, even though they may be clearly a solution for budgets." One workshop participant commented that home health care needs to address not only cognitive and physical impairments but also the emotional needs of patients dealing with a new diagnosis and family members dealing with the exigencies of patient care. Chris Herman, National Association of Social Workers, commented that difficult transitions do not end for families when hospice or home health care services appear.
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From page 45... ...
Jimmo and others as a national class action, she said, to address a long-standing problem that Medicare coverage is regularly denied on the basis of beneficiaries' restoration potential and not on the basis of whether they require skilled care. For many people with long-term and chronic conditions, the likelihood of health restoration may be negligible, yet skilled care may well be required for them to maintain their condition or to prevent or slow its worsening.
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What is needed, he said, is acquisition and analysis of the data on home health care to identify quality outcomes and best practices. As an illustration, Andrea Brassard, American Nurses Association, noted that her research on intensive home health care services in New York City in the 1990s found that these services did delay nursing home admissions and mortality among the sickest population.
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From page 47... ...
Regardless of the delivery model, however, payment should be made on the basis of patient outcomes. Meanwhile, it should be possible to build on Medicare Advantage and expand what it covers to include not just traditional health care services but also a continuum of health and social supports.
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