Preventive Medicine, Home Health & ACOs

February 9, 2012
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Although many of the independent providers I’ve surveyed seem less enthusiastic regarding ACOs and their viability to sustain those changes, I look forward to the changes, as it calls for increased accountability for PCPs. Over my 14 year career in the healthcare industry, I’ve observed (2) key areas that are extremely under-utilized: Preventive Medicine and Home Health.

Although many of the independent providers I’ve surveyed seem less enthusiastic regarding ACOs and their viability to sustain those changes, I look forward to the changes, as it calls for increased accountability for PCPs. Over my 14 year career in the healthcare industry, I’ve observed (2) key areas that are extremely under-utilized: Preventive Medicine and Home Health. Consumers (patients) are paying out of pocket ~$135 for preventative measures, such as the mobile health screenings for stroke, vascular disease, & osteoporosis that LifeLine Screening (www.lifelinescreening.com) provides. Doctors are unable to order these ultrasound tests due to the myriad of symptoms insurance companies require for authorization. (This is quite frustrating since the symptom of a stroke? A stroke. Osteoporosis? A broken bone. An abdominal aortic aneurysm? Death.) Catch my drift? These disease states are easily prevented, but don’t present symptoms which allow physicians to order them. The costs of a catastrophic event are tremendous, but at-risk patients are not regularly screened unless they pay out of pocket.

Home Health Care is also grossly under-utilized. According to the National Association for Home Care, approximately 7.6 million people in the US require some form of home health care. (http://www.mydoctodoc.com/Home_Health_Care.php) In most cases, Medicare covers 100% of the cost of home health, which can be ordered when a patient has a new diagnosis, is prescribed a new med, or has been hospitalized due to a fall, to name a few examples. Virtually any patient being discharged from the hospital would benefit from home health. But more often than not, it isn’t ordered. Why? Ask the discharge planner, “The PCP will do that”. Ask the PCP, “The Hospitalist handles that” -or- “I don’t use home health” (huh??) Ask the specialist, “If the PCP wanted home health they would order it. It’s his/her patient”. Ask the patient, “Oh, I can get home health? Who do I ask?” GOOD QUESTION!

Clearly, patients are falling between the cracks, & Drs are wrapped too tightly with red tape. Patients aren’t receiving the preventive care and home health services they’re entitled to, and hospitals are paying the price with NEEDLESS re-hospitalizations. ACOs are aimed at holding health care professionals accountable, expecting fewer trips to the hospital, shorter stays, reduction of unnecessary and duplicative services, and overall better quality care. ACOs, bring it on…we’re ready to revamp our healthcare system!