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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

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
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
barriers to home care
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
cost of care er vs home care
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
the healing arts
“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?
ltcip medical home visits
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
medical home visits as snf alternative
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”
what comes after the physician team at home
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