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JAMA Article Asks: What About “The Other Medical Home”?
Dr. Steven H. Landers writes a thoughtful article in today’s JAMA . He asks why the term Medical Home doesn’t include the patient’s home:
“…the Medical Home initiative, as currently articulated, ironically fails to emphasize the complex chronically ill patient’s actual home. This represents a failure to recognize the profile of the highest-risk beneficiaries driving much of the high Medicare costs—that is those with or more chronic conditions and activity limitations…
“A promising way to strengthen and broaden the Medical Home initiative for high-risk Medicare beneficiaries may be to make their actual homes the central venue of primary health care. This could be accomplished through another reform agenda that specifically empowers family caregivers, home health and hospice nurses, social workers, therapists, and personal care aides. This agenda places primary care physicians, advanced practice nurses, and physician assistants as partners and advisors to ongoing multidisciplinary care teams in the patient’s home.”
Dr. Landers provides some examples of reforms to consider for pilot testing:
- Expand the definition of home health skilled nursing need to include an ongoing care and continuity relationship role that extends beyond the 60-day episode window
- Ensure a loose interpretation of homebound requirements to include high-risk beneficiaries with multiple chronic conditions
- Provide a payment mechanism to hospitals and home health agencies for “hospital at home ” services
- Provide Medicare reimbursement for physician and nurse practitioner participation in multidisciplinary team meetings and comprehensive geriatric assessments, and increase he reimbursement rates and reduce the restrictions and compliance threats currently associated with billing for home and hospice care plan oversight.
- and 6 other examples
Hat tip to my colleague Dr. Bruce Leff for steering me to this.
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When my grandfather was receiving hospice care for his Parkinson’s and congestive heart failure, it was a gigantic benefit for him to be able to be at home instead of back and forth between hospitals and “nursing homes.” For as stubborn a fellow as he could sometimes be, he would have sooner refused any care at all than to be torn away from the house he spent his years in the workforce as a teacher to earn. It’s so important, especially for the elderly, that receiving care within their own home be an option. For those who are still mentally stable enough not to need constant watching but who are physically unable to perform their everyday tasks, this can be a huge comfort factor in their daily lives.
Very interesting.. After being in acute care for 13 years and then in home care for 15 years, the first time I read the the phrase “The Medical Home”, I actually thought I would read on to see the definition explained as just what you suggest here; more medical treatment taking place in the patient’s home… Honestly, my first thought after researching more about “the medical home” was “Hmmm… more of the “HMO” same, wrapped with a different bow.
Home care is definitely where care should first be delivered when at all possible… Just ask millions of patients about their home care experiences.. Most far outweigh that of any other environment where healthcare is delivered with outcomes being as good, and quality often better!