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November marks National Home Care and Hospice Month and one local provider is showing their appreciation for those �unseen champions of the health care system.�
�Our people are behind the scenes, in the homes. The only people they see are their patients and their family members,� said Mark Miller, administrator of community health at MERIL. �We want to use this opportunity to thank all of caregivers for going above and beyond and doing what they do so well.�
As of 2013, approximately 3.5 million Medicare beneficiaries received home health care at a total of $17.9 billion. There were more than 12,600 agencies nationwide providing home health care as of 2013.
Angels Home Health, a part of MERIL, provides home health care for qualified homebound residents in the area. The provide in-home services � such as rehabilitation, wound care or assistance with mobility � for patients unable to travel for out-patient care.
�We tend to visit patients several times a week, as infrequently as one time a week, depending on how much family support they have,� Mr. Miller said. �We do a lot of patient teaching in terms of avoiding infection, living as healthy as possible in the recovery process to avoid re-hospitalization at Mosaic or one of the hospitals in Kansas City.�
Ultimately, one of the biggest challenges in the industry is that many people don�t like being homebound, Mr. Miller said. Per Medicare regulations, recipients can only leave the house for medical appointments and to attend their house of worship to qualify for home health care.
She's put 250,000 miles on her Honda minivan going to their homes in upstate New York. Home visits make a different kind of care possible.
"You can evaluate the person as a whole," says Miller, who has been a home care physician in Schenectady, N.Y., for more than 20 years. "You see everything that influences their health and well-being: the environment, the surrounding people, the support system, whether they had or didn't have food."
Miller spends about an hour at each house call. Conversation with patients and their family members flows so naturally that it's easy to miss that she's also checking vital signs, gently stretching a hand, noting which pill bottles are empty.
Although Miller's practice may harken back to the country doctor of decades past, it could be the future of medicine. In 2013, about 2.6 million Medicare claims were filed for patient home visits and house calls. That's up from 2.3 million visits in 2009 and 1.4 million visits in 1999, according to Medicare statistics.
The trend is expected to accelerate as baby boomers grow older. One in 20 people over the age of 65 is homebound in the U.S., according to a study published in July in JAMA Internal Medicine.
"That's just the nature of the population we treat," Miller says. "They're extremely ill. Homebound patients often have up to 12 or 13 problems, not just one."
And they're often invisible. These people could be living just down the block, and you'd never know it. Many of them never leave their homes.
Miller's patients include a 55-year-old woman with ALS who can communicate only with her eyes, a 27-year-old former quarterback left quadriplegic and in a coma after surgery on an Achilles tendon, a 92-year-old woman cared for by her daughter, and a severely depressed man who lives alone.
After the Affordable Care Act took effect in 2014, Miller saw a spike in new patient requests after Medicare reimbursements increased for people who are disabled or 65 and older.
"Now we can afford to see them and take care of them. Because they haven't had medical care, they have multiple medical needs and psychosocial needs," she says. "It has given us access to a group of people, but more importantly, they have access to us."
But reimbursements declined in 2015 because of sequestration. And now Medicaid reimbursements rates are starting to fall as well.
GW�s Health Workforce Institute has partnered with the Health Resources and Services Administration to tackle the medical issues of the future with a new study on the role of "telemedicine" � using audiovisual media and technology to treat patients from different locations. Using these long-distance methods, providers can help bridge the gap in the quality of care for patients in regions with underdeveloped health care systems.
Patricia Pittman, an associate professor of health policy and management and co-director of the Health Workforce Institute, said she and others at the research institute will spend the next year doing a study on how often remote health care has been used at certain underdeveloped sites sponsored by the National Health Service Corps, where health graduates offer services for a period of time in exchange for loan repayment.
The Health Workforce Institute has an agreement with HRSA worth about $2 million over the next four years to study various issues involving health systems. This year's roughly $500,000 budget will be used primarily to research the technology-driven health care options.
GW sent out a survey in 2010 monitoring the use of telemedicine at that time. In 2015, the institute piggy-backed on a government survey to see how its use had shifted.
Though the remote technique offers multiple benefits, including reaching underdeveloped parts of the U.S. where access to medical care isn't guaranteed, telemedicine has gotten increasing amounts of pushback legislation-wise because of the difficulty regulating it on state and federal levels.
Pittman said that providing health care across state lines requires participation from federal and state government to solve issues like differences in medical licensing standards from state to state, as well as to decide types and amounts of insurance coverage.
�The federal level is important for Medicare payment. Medicaid payment is at the state level,� Pittman said. �In addition, the regulation of scope of practice and licensure of health professionals occurs at the state level, and this is a critical area of reform that could facilitate expanded use of telehealth.�
The program would also introduce a number of cost-saving measures. A telemedicine survey conducted by the Center for Information Technology Leadership in 2007 found that by using audiovisual measures, health centers could avoid up to 850,000 transports with an estimated savings of $537 million a year.
GW�s role in remote medicine extends beyond the research from the Health Workforce Institute. The University offers a telemedicine fellowship program for doctors completing an emergency medicine residency.
Neal Sikka, an associate professor of emergency medicine and the co-chief of GW�s innovative practice section, said that telemedicine will be an important step for making sure patients across the country are receiving the same level of medical care.
He said that since the use of this type of digital diagnosis and consultation is increasing in the workplace, medical students should become proficient in the technologies while they�re still in school.
�Graduating students and resident physicians will very likely be using telehealth in their future practice, so it is important that we start to give them tools and a foundation to be able to incorporate telehealth,� he said.
Students in the telemedicine and digital health fellowship spend two years learning the ropes with clinical practice, research, teaching and collaboration with the GW Medical Faculty Associates.
�Telehealth is a powerful tool to improve access to care for patients and a new paradigm of how we can deliver care,� Sikka said. �We hope to provide them experience that would allow them to be successful managing large-scale telehealth programs in their future practice, become innovators in the space, and work with startups and other companies that are working on new technologies to support improved health and health care access.�
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