Sunday, April 28, 2013

Health Quality Partners (PA) aims to keep elderly out of hospitals and nursing homes, but Medicare doesn't quite get that.

Medicare is cutting off an innovative program of home nursing visits, run by a Pennsylvania group called Health Quality Partners, when the impetus should be toward home management of chronic disease to prevent hospitalizations, as Ezra Klein explains in the Business Section of the Washington Post Sunday, in a very detailed, booklet-length article. The title is “If this were a pill. You’d do Anything to get it,” link here
Health Quality Partners has a very visible website and simple domain name, here
While Medicare says that it is working on coming up with quality management and getting away from so much reliance on “fee for service”, its bureaucratic assessment procedures seems to have obscured the value of home health.
I rather expect to see a paper on this from Lewin, a consulting company for which I worked in 1988-1990.  The closest I could find is a new paper on long term care here. (I note with regret  the passing of the company’s founder as explained on the site.)
My own mother had regular visits from hospice nurses during her last year, and quality control visits from a nurse for a company providing home care aides.
The tendency for families to become “fragmented” will make reliance on home care more difficult, as I’ve often noted on these pages.
There’s one particular angle to the Klein story that occurs to me.  Physicians often tend to press patients into more tests, partly to avoid malpractice liability, but also out of a mentality that early intervention on problems will prolong lives.  (Look at what happened to David Letterman in 2000.)  When the intervention is invasive and requires hospitalization of someone who is productive and has “momentum” in life, the end result could be counterproductive.  Don’t go to the hospital unless you absolutely have to,  The infection issue keeps getting worse.   

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