Now is the Time to Invest in the Medicare Home Health Program

Newswise — New Brunswick, NJ -- The decision to place an older relative into a long-term care facility or nursing home is always difficult. Many older Americans yearn to maintain independence in their own home, where they may have lived for decades and raised their families, but struggle due to acute and chronic illnesses that enhance limitations that come with age. Medicare supports home health services including visiting nurses and therapy, but according to Steven Landers, MD, MPH, clinical associate professor at Rutgers Robert Wood Johnson Medical School, the current policy should be strengthened to limit fraud, provide consistent services nationally to reduce health disparities and allow for better care coordination.

“The Medicare home health benefit is the most important piece of our national commitment to helping senior citizens age-in-place,” said Dr. Landers, who also is president and CEO of the Visiting Nurses Association Health Group. “As the medical community is beginning to care for about 76 million Baby Boomers as they age, now is the time to invest in home health.”

Dr. Landers, in a Viewpoint piece published Online First on September 26 in the Journal of the American Medical Association, says that the enactment of the Affordable Care Act (ACA) is the perfect opportunity to improve home health care. According to Landers, implementing changes to the Medicare policy means utilization of home health agencies for management of acute and chronic health conditions reduces the risk of emergency room visits and rehospitalization, thereby reducing healthcare costs for both the government and the patient.

Improving the value of home health can be accomplished, he said, through payment reform initiatives already included in the ACA. “Home Health Agencies should be better aligned with payment reform to allow them to support physician-directed care, help older Americans transition from a hospital to home, and assist with chronic disease management,” he said.

“I believe Dr. Landers makes some excellent, thought provoking recommendations,” said Alfred Tallia, MD, MD, MPH, professor and chair of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, “The Home Visit Service at Rutgers Robert Wood Johnson Medical Group has experienced an explosive increase in demand for services, and Dr. Landers’ recommendations would go a long way to helping us better serve patients in the home, which is where patients prefer to be, and where costs can be significantly less than in other settings.”

Additional changes recommended by Landers include “bridging” interventions that improve the transition from a hospital to home health care. This would reduce the dangerous 24- to 72- hour gap of care that now exists following a patient’s discharge.

Landers also suggests better oversight of home health agencies and requiring the organizations to employ a medical director who can supervise care plans, make home visits and ensure that proper protocols are implemented and followed.

Aiding each of Lander’s suggestions would be the integration of home health care records with a patient’s electronic medical record (EMR) and allowing telehealth interactions. An integrated EMR ensures that all caregivers understand a patient’s health history and medical requirements to continue living safely at home. Telehealth, where patients and caregivers can communicate remotely either by phone or video conference, improves access for patients and offers efficient oversight to ensure the patient is stable.

Landers holds steadfast to the belief that the nation should invest in education and research of home health care, which would provide evidence to the substantial, positive impact on economic outcomes and more importantly, allow Americans to age gracefully and comfortably at home.

“By revisiting the nation’s home health policy, there is an opportunity to improve quality, independence, and compassion for the largest group of older American in the nation’s history,” Landers said in closing his Viewpoint in JAMA.

About Rutgers Robert Wood Johnson Medical SchoolAs one of the nation's leading comprehensive medical schools, Robert Wood Johnson Medical School, part of Rutgers, The State University of New Jersey, is dedicated to the pursuit of excellence in education, research, health care delivery, and the promotion of community health. In cooperation with Robert Wood Johnson University Hospital, the medical school's principal affiliate, they comprise New Jersey's premier academic medical center. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.

Robert Wood Johnson Medical School encompasses 20 basic science and clinical departments, and hosts centers and institutes including The Cardiovascular Institute, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate, and postgraduate levels for more than 1,500 students on its campuses in New Brunswick and Piscataway, and provides continuing education courses for health care professionals and community education programs. To learn more about Robert Wood Johnson Medical School, visit rwjms.rutgers.edu. Find us online at facebook.com/RWJMedicalSchool and twitter.com/RWJMS.