“More and more older adults are homebound and have a hard time getting to their medical providers,” said researcher Dr. Justin B. Mutter, the section head of Geriatric Medicine at UVA Health, who provides home visits through UVA’s Virginia at Home program. “House calls bring the best of person-centered medical care to where many need it most: their home environment.”
UVA Health launched Virginia at Home last summer, in collaboration with the Department of Neurology’s Memory and Aging Care Clinic and the UVA Center for Health Humanities and Ethics. Virginia at Home’s interprofessional team consists of Mutter, nurse practitioner Karen Duffy, clinical pharmacist Bethany Delk and care coordinator Tuula Ranta. The team helps patients age in place, provides caregiver support and offers house calls as well as telemedicine visits, in partnership with UVA’s Center for Telehealth. The program aims to bridge the gap between high demand for, and low supply of, home-based medical care for older adults in Central Virginia.
Obstacles to Home Care
The researchers note that many obstacles hinder the delivery of home care across the country, including Medicare reimbursement rates, travel time and the complexity of many homebound patients’ needs. A family doctor may see 20 patients a day in an office-based setting, while many home-care providers are unable to see half as many patients in that same time, the researchers say.
To overcome those challenges, Medicare likely would need to revisit how it compensates providers for home visits. “Home-based medical care … has been described as a low-volume, high-value service that is not easily rewarded by fee-for-service payment,” the researchers write in a new paper outlining their findings. For this reason, they say, integrating value-based payment options within traditional Medicare for homebound older adults will be essential.
The Virginia at Home program has benefited from the generous support of philanthropic gifts for its launch, but philanthropy must be complemented by sustained payment reform for all home-care providers, Mutter and Yao say.
Without such steps, America will continue to struggle to keep pace with the growing demand for home-based medical care in the years to come, the researchers say.
“Home-based medical care is care built around the patients and caregivers with goals tailored to their needs in their environment,” Mutter said. “Now more than ever, we need health care professionals trained and ready to provide this holistic service to our aging population.”
Findings Published
The researchers published their findings in the scientific journal Health Affairs. The research team consisted of Yao, Mutter, James D. Berry, Takashi Yamanaka, Denise T. Mohess and Thomas Cornwell. Yao disclosed he has holdings in Heal Inc.; a full list of the authors’ disclosures is included in the paper.
Mutter was supported by grant K01HP33445 from the Health Resources and Services Administration, a division of the Department of Health and Human Services.
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