Physician viewpoint: Home care needs a new payment model

The shift to home services has been accelerated by the COVID-19 pandemic as home-based care has become one of the ways to mitigate spread to patients while clearing up capacity at hospitals.

The quick shift to new home-based services has highlighted a concern in the way these types of services are paid for, physician researchers with the University of Pennsylvania in Philadelphia and Humana wrote in a viewpoint article published in JAMA.

Under traditional Medicare payment models, home services are linked with recovery from acute events. Clinicians have to certify that a Medicare patient is homebound to be eligible for payment. In light of the pandemic, CMS issued a waiver to relax some of these regulations.

But care during recovery is only a small part of what kinds of care can be delivered in the home at a lower cost and possibly higher quality, the physicians wrote. The physicians outlined what an ideal payment model would look like for other types of clinical, behavioral and social needs.

The physicians pinpointed four principles this model should consider:

1. Clinicians and healthcare organizations should be incentivized to deliver services that, when considering cost and alternatives, are most likely to benefit patients. 
2. The model should meet patients where they are.
3. Preventive and treatment services should be valued appropriately.
4. Customization should be supported by the payment model. 

View the full viewpoint article here

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