Changing healthcare models: What's the impact on home care?
The Affordable Care Act: Has there been such major health policy reform in the United States since the 1965 passing of the Social Security Amendments? A goal of the ACA is changing payment models based on the belief the current healthcare payment model is broken. It has been suggested the core of the problem is the fee-for-service system, which opponents argue promotes high utilization without appropriate accountability for cost, quality and outcomes.
The ACA intends to shift away from a reactive, fee-for-service model to a more comprehensive, holistic and patient-focused approach with clinical and cost outcomes being the measure of success. New payment models that focus on care coordination, clinical efficacy, improved quality, efficient care, patient satisfaction and reduced cost are replacing the FFS system and will become the new standards for payment. New models include: accountable care organizations, which may assume partial or full risk for the cost of care for a population of patients (population health); medical home models with shared risk; bundled payments for episodes of care that cross the continuum of care; and pay for performance incentives tied to myriad quality and outcome metrics. HME providers, along with other healthcare organizations, will be required to enter agreements with payers that incorporate new financial and operational models. Some models may incorporate a mix of payment methods. Alternate payment models demand that patients receive the right care, at the right time, in the right place, and at the right cost.
The overriding goal of healthcare reform is to improve the quality of care, while concurrently reducing cost. It is hard to make such a strong statement without contemplating the role of the homecare provider. Home care is the lowest cost environment of care and clearly the preference for patients and caregivers. However, there is more to home care than the equipment, which unfortunately CMS and competitive bidding fail to recognize. Patient and caregiver education and training, along with clinical assessment and intervention, have long been core elements of many successful homecare programs. Although the value of these is not recognized or accounted for in competitive bidding, they will prove important in a more global view of care that is driven by different payment models. As health systems and groups enter into these new models, many will find themselves in uncharted territory. This knowledge gap will create new opportunities for homecare providers to collaborate on post-acute and chronic care. Homecare providers need to engage in strategic and aligned relationships within the local and regional healthcare community and payers.
Change creates gaps, which, if you’re optimistic, are opportunities.
Joseph Lewarski, BS, RRT, FAARC, is vice president of the global respiratory and sleep categories for Drive DeVilbiss Healthcare. He can be reached at firstname.lastname@example.org.