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? n Mid-level (extender) services & scope of practice in CA n Credentialing n Reimbursement –Medicare provider (IPN) –“Incident to” billing (SNF & rehab) –Medical malpractice liability coverage n My background

3. Barriers to Home Care n CMS Review Committee (current & past claims) n Home care: most scrutinized, denied, and inappropriately compared to cohort groups (with example) n Cultural & generational resistance n 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 n 80% ER visits by 75yo+ unnecessary* n ER ave=___; HC ave=____ n Incentive for local docs: reimbursement (15% higher for home care) n Portability & miniaturization of technology allow full services of urgent care at home –UTIs, CHF, Pneumonia n 24/7 free home pharmacy delivery n Affordable ambulance transport for hospitalization when necessary

5. “The Healing Arts” n End of Life @ 2 years n Re-infuse aging process w/respect & dignity n MDs in home grow to leave behind the “business” of health care & embrace the healing arts n MD becomes guest n Consumer has locus of control n What’s in it for the clinic doc?

6. LTCIP & Medical Home Visits n 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 life quality n Outcome measures for LTCI: <acute, < admin days/costs, <pt & family distress n LTCI to support medical home visits n Membership to AAHCP? n Support for needed policy changes

7. Medical Home Visits as SNF Alternative n Consumer and caregiver choice n EOL in own environment: safely & comfortably dying @ home n Cost of EOL care in hospital vs home n Quality of EOL care in hospital vs home n #1 Marketing tool: “What your customers tell their friends about you”

8. What Comes After the Physician Team at Home n The “pass-off” from MD team to care manager n Why MD team does not do care management n Provider of Care Management: Cyndi Hasz