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A home health bulletin distributed to our physicians January, 2009

Expanding Care for
Mental Health

A Call to Action:  The Surgeon General reports that mental disorders account for more than 15 percent of the overall, economic burden of disease.  Even with an estimated 50% of psychiatric disorders going undiagnosed,(1) their cost ranks higher than all forms of cancer combined.  Depression alone produces as much suffering and disability as heart disease or diabetes.(2) 

The Role of Psychiatric Home Health: Psychiatric home health is a specialty of Medicare certified home health that utilizes nurses with extensive experience in mental health.  Complimenting normal psychiatric care delivery systems with the addition of in-home interventions has resulted in significant reduction in both hospitalization admission and recidivism rates.(3)  Mental health home care programs have also been associated with cost reductions of up to 68%, improvement in mental conditions, social functional outcomes, and service satisfaction.(4)  Psychiatric home health promises to be an important tool for physicians in terms of controlling national healthcare costs while improving patient care.  In general terms, psychiatric home health nurses use many of the same approaches home health nurses use for care of common chronic diseases.  They work with both your patient and your patient’s at-home caregivers to enhance education about important medications, coping strategies, disease recognition, and disease management.  In the home environment, psychiatric nurses can work on issues such as transition from in-patient facilities, caregiver concerns, lack of structure/involvement in daily activities, structural and functional factors affecting adherence, and the presence of persistent symptoms.  Your patients may or may not have been exposed to some or all of the same data in other settings, but the home health model for reinforcing disease management education consistently results in greater understanding, adherence, and patient / family peace-of-mind.

The Role of the Family Practitioner:  AbleCare receives psychiatric home health referrals from both psychiatrists and family practitioners.  In 1996, the Health Care Financing Administration (now CMS), broadened service capacities by allowing all physicians, not just psychiatrists, to sign a Medicare psychiatric plan of care.  The official position of the American Association of Family Practitioners is that “Through residency training and continuing medical education, family physicians are prepared to manage mental health problems . . .”  For reasons that sometimes revolve around economics, primary care physicians actually provide the majority of mental health care.(5)  Estimates suggest that 11% to 36% of primary care patients have a psychiatric disorder.1  If you have patients showing non-adherence to psychiatric medication, having family problems revolving around a psychiatric condition, or receiving repeated admissions to in-patient facilities, consider AbleCare’s psychiatric home health as a possible extension of your care.  In addition, if you have patients with physical maladies accompanied by psychiatric comorbidities, please bear in mind that AbleCare is one of the few providers who has extensive experience in both domains. 

Medicare Pays 100%: As with other home health services, Medicare pays 100% of psychiatric home health for qualified patients.  Qualified patients have no co-pays, deductibles, or other out-of-pocket costs.  The normal skilled need qualification applies, but there is one important exception to homebound status.  Medication teaching and disease management teaching usually meet the skilled need requirement.  Patients with a psychiatric diagnosis that manifests itself in a refusal to leave the home or with a psychiatric condition that would make it unsafe to leave the home unattended qualify as homebound even in the absence of physical limitations.

One Nurse + One Patient =
Greater Peace of Mind

Home health can send a disorienting number of people into the homes of your patient.  At AbleCare, we assign one nurse to each of your patients, and that one nurse makes all the skilled nursing visits.  This reduces the likelihood of errors during care transitions, and it enables your patients to form a good relationship with our home health nurse.  In your business, you know how important relationships can be.

Please offer AbleCare Home Health
to your patients. 

References

1. Tiemens B, Ormel J, Simon G. Occurrence, recognition, and outcome of psychological disorders in primary care. Am J Psychiatry 1996; 153(5): 636-44.
2. Well K, Sherbourne C, Schoenabaum M, et al. Impact of disseminating quality improvement programs for depression in managed care. JAMA 2000; 283(2): 212-20.
3. Biala K. Psychiatric home health: the newest kid on the block. Home Care Provid. 1996 Jul-Aug; 1 (4): 202-4.
4. Tsai S, Chen M, Yin T. A comparison of the costs-effectiveness of hospital-based home care with that of a conventional outpatient follow-up for patients with mental illness. J Nurs Res. 2005; 13(3): 165-73.
5. Gallo J, Coyne J. The challenge of depression in late life: bridging science and service in primary care. JAMA 2000; 284 (12): 1570-2.