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Steven Landers MD in JAMA: “Payment reform initiatives in the ACA offer opportunities for improving the value of home heal

Posted Sep 28 2013 10:01pm

Posted on | September 26, 2013 |

“Payment reform initiatives in the ACA offer opportunities for improving the value of home health care. These include independence at home programs, accountable care organizations, bundled payments, patient-centered medical homes, and readmission reduction initiatives. These approaches incentivize physicians and hospitals to partner with HHAs to avoid unnecessary hospitalization and institutionalization while also avoiding marginal HHA utilization. However, in these models, home health is “downstream” from physicians and hospitals and there could be perverse incentives; careful review of the outcomes and utilization patterns is necessary. These new models are also limited in how creative they can be with home health because of the established rules and benefit structure. For example a physician in an accountable care organization, independence at home program, patient-centered medical home, or bundled payment program may want home nursing services for a high-risk patient to achieve a better clinical and financial outcome, but the patient is not clearly homebound or just needs one “coaching” visit and thus would be ineligible for home health. To better align HHAs with payment reform, regulations should be relaxed in the specific domain of these programs. This will allow HHAs to support physician-directed care coordination, care transitions, and chronic disease management initiatives in the context of cost accountability. To further improve coordination, health information technology policy should address integration of home health records with medical records. In addition to the ACA, further reforms are necessary to ensure that older Americans get the home support they need and Medicare gets value.”

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