Better Training, Reimbursement Needed to Sustain Growing Demand for Home-Based Care Amid COVID-19

The coronavirus has shed new light on the importance of home-based care. Even after the virus fades into a painful memory, in-home care will remain firmly rooted in the fabric of the U.S. health care system.

At least, that’s what stakeholders like Brent Feorene — executive director of the American Academy of Home Care Medicine (AAHCM) — are hoping for.

“Home care medicine … will be reinforced as a major part of the health system, and there will be increased demand for it,” Feorene told Home Health Care News. “I also think the telehealth regulatory relief we’ve had, that genie is not going back in the bottle.”

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AAHCM is a professional organization that has more than 1,000 interdisciplinary members, about half of which are physicians and another quarter of which are advanced practice providers. Remaining members include social workers, nurses, therapists and other professionals on home-based care teams.

Feorene’s view echoes what other home-based care stakeholders have been saying for months.

That includes folks in the home care realm, like Interim HealthCare CEO Jennifer Sheets; leaders in the hospital-at-home space, like Bruce Leff, the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine; and just about everyone in between.

“This virus is going to rewrite the rules of the health care system,” senior care thought leader Dr. Bill Thomas recently told HHCN. “I predict that home- and community-based services — especially those that are really integrated and based on population health — are going to come to the forefront as a result of this COVID-19 epidemic.”

But to sustain the shift everyone is expecting, planning and payment for home-based care must also change, AAHCM President Theresa Soriano told HHCN. Soriano is also a home-based primary and palliative care physician in New York.

Historically, home-based care has been plagued by the misconception that it’s not as high-quality or intensive as care delivered in institutional settings. But the reality is all sorts of care can be delivered in the home, from non-medical home care to hospital-at-home treatment of relatively high acuity patients.

“In fact, when you’re in the home … you actually have to have much higher clinical skills and you don’t have the X-ray right there,” Soriano said. “You have to really know what’s going on.”

She believes a large reason for the misconception is inexperience. From CNAs to medical doctors, many health care professions have never delivered care in the home until they start working for a home-based care company, as it’s rarely taught in school.

“It’s not something you learn in medical training, no matter what discipline you’re in,” Soriano said. “So how do we cultivate and work with training programs … to bring this education to the forefront so we can train more people who actually want to do this?”

Part of the answer lies in payment.

Typically, health care workers — such as nurses — can expect to make more money in institutional settings — such as hospitals — rather than in the home. As such fewer professionals are inclined to choose community care settings. It’s a function of lower reimbursement for home-based care services.

To fix that and make the home a more enticing care setting, the government needs to make reimbursement for home-based care more sustainable, Soriano said.

“Where some international countries have grown home-based medical care far faster than we have … is to find that reimbursement model that allows this kind of interdisciplinary, home-based care to be sustainable as a business, whether you’re public or private,” she said. “So it’s really important to not forget about the advocacy needed to make sure the model itself — whether we’re using telehealth, video visits, etc. — is something that can actually be sustained over the long course in terms of reimbursement models.”

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