Laying It on the Line: Physician Advocates for Stronger Home Health Options

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Advocating Stronger Home Health OptionsDr. Steven Landers, president and CEO of the Visiting Nurse Association Health Group in Red Bank, New Jersey, did not hold back in his recent Journal of the American Medical Association (JAMA) article on the future of home health. “To better align HHAs (home health agencies) with payment reform, regulations should be relaxed [to allow] HHAs to support physician-directed care coordination, care transitions, and chronic disease management initiatives in the context of cost accountability,” he writes.

“The Future of the Medicare Home Health Program” was published Sept. 26 on the JAMA website. Landers addresses a wide range of issues, including the “confusing ‘homebound’ criterion,” the need for better alignment of payment with value, the evidence for bridging interventions and the fact that telehealth is not covered under the current program.

In addition to noting how Landers lays out his arguments and observing his supporting evidence, home health agencies will be interested in his thoughts on clinician oversight. Landers says all home health agencies should be required to have medical directors who are responsible for quality initiatives, clinical protocols, patient appropriateness and ensuring attentive medical supervision. He believes those directors should be required to be available for home visitation in an effort to reduce fraud and improve overall care.

The section on care coordination also contains observations that would present a radical shift from today’s approach to the home health episode of care. Landers advocates starting each home health episode with a hospital visit. “[This] will permit full implementation of evidence-based concepts and eliminate the potentially dangerous 24- to 72-hour gap when patients have been discharged from the hospital and are not yet receiving assistance from the HHA,” he writes.

Home health executives also will be interested in Landers’ views on value payments. Landers advocates for new payment incentives – ones based on risk-adjusted outcomes and improvements between actual and expected hospitalization, rehospitalization and institutionalization rates. He even offers a recommendation for the savings. “The savings could be used to maintain stronger home health reimbursement for exemplary HHAs,” he says.

Note: Dr. Steven Landers is not affiliated with McKesson, and his views and opinions are his own.

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