House Call Program

[LoisJean]

The mention of a MD/NP house call program has kept me in reverie for the past few days. Thanks for the mention of it, Nurse Karen.

More and more I see the advantages of such a program in the Home Health Care arena. My home care business contracts with two Medicaid Waiver programs and as independant nurses we see situations in the home where this kind of networking would be most beneficial for many of our clients and would certainly enhance the overall continuity of care between all agencies who provide direct patient care within the home. I don't know about you guys, but continuity of care can be a real big problem in the rural areas in which we work.

I am curious as to how this type of program would be set up. How would this work within the community setting and how would it affect communication between the visiting MD/NP and the patient's primary physician? I've got lots more questions about this, I just can't get my frontal lobe to co operate right this minute.

Karen, if you can could you kind of elaborate a bit more on what you want to formulate regarding this subject?

Any info would be much appreciated....please send me private email if you prefer--but, I think this is a topic that needs to be made more public in this forum. Thanks much--LoisJean

[NRSKarenRN, BSN, RN]

LoisJean:

While I was a clinical coordinator at my previous employer, I managed nurses caring for 160 Wavier and 40 Options clients, most served by Philadelphia Corporation for Aging; also Delaware and Montgomery County Office of Aging programs.

A little background:

The Office of Aging Progams provide services to adults over 65 and disabled individuals aged 21 to 65 (onset of disability is important, be it before or after age 21 makes you eligible for certain services).

Federally funded programs are provided thru Act 150 Programs ( clients don't meet medicaid eligibility requirements) and Attendant Care Medicaid Wavier services.

In PA programs known as Options (non- MA eligible or don't meet SNF level of services, provide up to 40 % of SNF costs to maintain at home) and Wavier (meet SNF and MA eligibility guidelines, provide up to 80% cost of SNF care). These programs grew significantly since ~ 1996 when Wavier program started in Philadelphia.

Their goal is to maintain disabled and elderly home bound residents in their own home with in-home personal assistace services such a bathing, dressing, grooming, meal preparation, housekeeping and limited brief skilled services (RN, PT, OT, ST: mainly skilled assessment of safety issues esp. equipment checkout and medication compliance review; Waiver also pays for dietician).

What I know re NP Programs + homecare:

With this explosion of homebound services, clients formerly placed in Long term care (LTC) facilities are now homebound without means for medical care except by WC van or ambulance.

Nurse Practioners are ideal for caring for clients with chronic illness esp. Geriatric and Family Nurse Practioners. Main goal: Keep clients out of the hospitals!

In Philadelphia, three doctor's groups make house calls. Penn Ralston House, a senior Center/LTC facility, part of Univ. of Penn , developed onsite medical clinic and branched out in ~1996 to managing homebound clients in it's West Philadelphia neighborhood. VNA of Philadelphia developed NP house call program in~1998. One DR group added an NP 1 1/2yrs ago.

One program has MD/DO make initial visit with NP doing followup and MD PRN visits; VNA has NP make first visit with MD review of assessment, and NP totally manages care with MD prn visits. They become the family medical practioner/doctor. Office of aging program clients are referred to the groups if truly unable leave home. The also get referrals from word of mouth, Nurses and homecare agencies and advertising.

Additionally , what helped is MC /MA stating that NP can bill under own license 80% cost of MD visit. For other insurances, a NP would need to establish a contract with insurance CO-- not sure if MC+ Choice programs are approving contracts and paying for services.

I'm most familiar with Home Care Agency's billing MC; just learning doctor billing over past year.

Found this wonderful info on NP's and billing via medscape.com website provided by Carolyn Buppert, a Lawyer.

She has monthly newsletters, a Green sheet: focus on The latest on compensation and reimbursement for NP's and a Gold Sheet: focus on quality issues for NP's.

Check out What has to happen to bill for NP services performed in patient's home, nursing home or hospital?

http://nurses.medscape.com/CBuppert/GreenSheet/2001/v03.n02/gree0302.html

Registration @ medscape is required and free at current time.

Also check out other months billing info.

I get medscape weekly delivery to computer and have found most of the info I am posting at allnurses from medscape.com and healthleaders.com (get Daily delivery, free registration).

If you desire, I can email privately above agency's tele #'s for you to contact them. Also found info on Drs in Las Vegas with huge homebound practice, tucked away so carefully, can't find ( found on Yahoo seach re house call +doctor's).

Hope this helps. I am doing Family NP program cause I need to learn more about women's health, developmental disabilities, children and youth, AIDS programs etc since past 20 years in adult homecare, well child summer camp. Then want to establish NP housecall program for my homceare agency as large underserved impoverished home bound population in Delaware + Phila. Counties