Physician Assistants : Where Do We Fit In? :
Physician Assistants : Where Do We Fit In? Mid-level (extender) services & scope of practice in CA
Credentialing
Reimbursement
Medicare provider (IPN)
“Incident to” billing (SNF & rehab)
Medical malpractice liability coverage
My background
Barriers to Home Care :
Barriers to Home Care CMS Review Committee (current & past claims)
Home care: most scrutinized, denied, and inappropriately compared to cohort groups (with example)
Cultural & generational resistance
American Academy of Home Care Physicians
Top leadership: George Taler, and Gresham Bayne, Ed Ratner, MDs
Goals: inititate changes to Medicare law for geriatric residencies & reimbursement for home care
Cost of Care: ER vs. Home Care :
Cost of Care: ER vs. Home Care 80% ER visits by 75yo+ unnecessary*
ER ave=___; HC ave=____
Incentive for local docs: reimbursement (15% higher for home care)
Portability & miniaturization of technology allow full services of urgent care at home
UTIs, CHF, Pneumonia
24/7 free home pharmacy delivery
Affordable ambulance transport for hospitalization when necessary
“The Healing Arts” :
“The Healing Arts” End of Life @ 2 years
Re-infuse aging process w/respect & dignity
MDs in home grow to leave behind the “business” of health care & embrace the healing arts
MD becomes guest
Consumer has locus of control
What’s in it for the clinic doc?
LTCIP & Medical Home Visits :
LTCIP & Medical Home Visits Disease Management Model vs. Population Health Model
DM has patient seek ambulatory care programs
Superimpose DM w/multiple chronic and functional conditions
PHM transfers responsibility from pt. to doc: results in <hospitalizations, > life quality
Outcome measures for LTCI: <acute, < admin days/costs, <pt & family distress
LTCI to support medical home visits
Membership to AAHCP?
Support for needed policy changes
Medical Home Visits as SNF Alternative :
Medical Home Visits as SNF Alternative Consumer and caregiver choice
EOL in own environment: safely & comfortably dying @ home
Cost of EOL care in hospital vs home
Quality of EOL care in hospital vs home
#1 Marketing tool: “What your customers tell their friends about you”
What Comes After the Physician Team at Home :
What Comes After the Physician Team at Home The “pass-off” from MD team to care manager
Why MD team does not do care management
Provider of Care Management: Cyndi Hasz