'Home Health Care: Worth A Closer Look' by Mario Motta, M.D.

In our constant efforts to control costs and improve quality in our delivery of health care, we may have found another area that deserves more attention than it's getting: home health services. That's the headline from a recent survey of physicians conducted by the Massachusetts Medical Society.

Conducted in collaboration with the Home Care Alliance of Massachusetts, the survey represents one of the few efforts to learn more about the under-examined area of physician use of home health services such as skilled nursing care, physical and occupational therapy, speech-language therapy, and medical social services provided in the home.

The survey report revealed some startling numbers. More than 89 percent of responding physicians said they believe home health services can reduce inpatient hospital admissions, 67 percent said remote monitoring services can reduce costs, 63 percent said they can reduce emergency room visits, and 41 percent stated they can produce overall costs savings. And a stunning 97 percent said the services help them better manage their patients' care at home.

These findings can be significant in developing future health policy, as our population ages and as our physician workforce - especially primary care and geriatrics - becomes increasingly strained year after year. The number of adults 65 and older will double in the next 20 years, and life expectancies are increasing. Those factors, along with current and projected shortages of primary care and geriatric physicians, are adding intense pressure on health care access and delivery for seniors - as well as future health care costs.

An additional benefit of home health services may be to provide some relief to primary care physicians - a specialty whose use of such services is very high.

The survey found that 64 percent of primary care physicians use the services for chronic disease management, and 82 percent use them for hospice and palliative care.

Pat Kelleher, executive director of the Home Care Alliance of Massachusetts, which has some 150 member agencies across the state, sees the potential. "As the state looks at system redesign and cost efficiency," she says, "the survey indicates that strengthening relationships between physician and home health care would be more promising than reinventing new models of care coordination."

Currently, the Alliance estimates that more than 150,000 people in the state are served by home care services through Medicare, Medicaid, and private insurance, with 100,000 of those being senior citizens on Medicare. Those figures do not include patients assisted by private funding. The numbers are apt to increase along with ages of our citizens.

Another key benefit to such services is reducing caregiver stress: 73% of responding physicians cited this benefit, an important consideration as more and more family members are pressed into caring for their elders for longer periods of time. According to the National Alliance for Caregiving, an estimated 44 million Americans age 18 and older - about 21% of the population - provide unpaid care to another family member. And recent research and published reports have indicated the economic recession has put further strain on caregivers: as services are cut, caregivers are carrying much more of the financial load for care and in many cases are dividing time between working and caregiving.

The survey did note some negatives. Physicians cited administrative burdens (paperwork), reimbursement issues, and availability of workers as barriers to using the services. But none of these appears to be overwhelming. The barrier of reimburse-ments, for example, can likely be removed by education: of the 71% of physicians who reported that they did not submit charges to Medicare for the services, 64% said they were unaware of the reimbursement. And reducing administrative hassles has been a long-desired goal for any number of activities all throughout the health care system.

As health care costs continue to rise relentlessly, we should take every opportunity to look for reasonable ways to reduce costs and improve care. From the physician's perspective, home health care services could be one way to ease costs, reduce the pressure on primary care, and maintain quality of care. It's certainly worth a closer look.

Mario Motta, M.D., a cardiologist in Salem, is President of the
Massachusetts Medical Society.