Posted on | February 11, 2014 | No Comments
In a 2013 article in JAMA, Steve Landers laid out the argument for money following the patient. Destination? Home, where family caregivers and others are increasingly doing their best to manage health care complexity. In the article Landers states:
“Most older Americans want to age in place. The Medicare home health benefit is a prominent national policy supporting older Americans at home and provides for visiting nurse and therapist services from home health agencies (HHAs). In 2012, Medicare spent $18.2 billion on HHAs; 3.5 million beneficiaries received care. Home health can help struggling patients get support in the community and can enable successful transitions home from institutional care. However, numerous concerns have been raised about the home health benefit, including fraud, geographic variation in utilization, and poor coordination with primary medical care. This uncertainty is untimely, as more than 70 million adults will join Medicare between 2011 and 2030 with the hope of receiving care at home. It is time to develop a stronger home health option.”
Later, he outlines how payment might be scientifically aligned with evidence.
“Payment incentives should be developed based on risk-adjusted outcomes and improvements between actual and expected hospitalization, rehospitalization, and institutionalization rates and the savings could be used to maintain stronger home health reimbursement for exemplary HHAs. Special consideration will be needed to ensure complex patients are not inappropriately disadvantaged. Additional outcome measures focused on family caregivers should be added because caregiver function represents important economic outcomes of home health not captured in current measures.”
Navigating this Catch-22 may be made possible with ACA induced delivery experimentation and reshuffling. But one thing is for certain, waiting around in place for a financial incentive is an increasingly weak physician leadership strategy. Already there are ample signs that others are finding a way to achieve mobility, connectivity, and home entry. Can you say, “Mobile Minute Clinic”?
I recently asked a national leader in Medicine what he thought of my “just-made” remark from a podium that “Physician job descriptions have not been rewritten in 100 years, and we need to go through the exercise”. His response, “I think many physicians would say that others have already changed the physician’s job description.”
My reaction? That may be true. But that’s what happens when you wait around. Someone else finally takes the lead, and you get left in the dust. There is an opportunity for physicians to lead in home-centered health care still. But to do so, they’ll have to redefine their jobs, and meet the patient half way.
So here are five concrete steps I’d suggest for physician organizations and health care organizations employing physicians:
1. Convene a multi-disciplinary group to write a modern physician job description. What are required of all physicians? What additional responsibilities may be required of different types of physicians?
2. In creating the job descriptions, focus on broad geographic reach and population health.
3. As part of the exercise, attempt to maximize physician training and skill set, and define with accuracy team membership and responsibilities if the physician is to be a team leader.
4. Assess any additional training and support that may be required for the physicians to succeed in their new roles.
5. Include identified family caregivers (formal and informal) as well as the patient, as team members, and prepare a job description for them as well.
For Health Commentary, I’m Mike Magee