• OUR MISSION

    Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.
40::43

Policy Compendium

Policy Compendium Home

View Access & Financing Policies

HOM-003: Home Health Care Services

 
Home Health Care Services: The Wisconsin Medical Society

  1. Supports the concept of home care, which has been recognized and utilized as a viable mode of health care by organized medicine for decades.
  2. Defines home health care as that component of a continuum of comprehensive health care whereby health services may be provided to individuals and fami­lies in their places of residence for the purpose of promoting, maintaining or restoring health, or of maximizing the level of independence, while minimizing the effects of disability and illness, including terminal illness.
  3. Supports services appropriate to the needs of the individual patient and family that are planned, coordinated, and made available through the use of employed staff, contractual arrangement, or a combination of the two patterns.
  4. Believes that agencies providing home health care should be licensed by the State of Wisconsin and offer a broad spectrum of health services from acute, intensive treatment and rehabilitative care to long term or maintenance level supportive care.
  5. Supports making home health services available based upon patient care needs as determined by an objective patient assessment administered by a multi-dis­ciplinary professional team or a single health professional in consultation with the patient’s physician.
  6. Believes that physicians should be provided with periodic reports of the type and frequency of home care services delivered as well as the patient’s response to the care provided.
  7. Recommends that physician/patient visits should occur as indicated by the pa­tient’s condition.
  8. Recommends that home care services:
    1. are provided under the direction and plan of care (developed prior to dis­charge for those who are to return home from a hospital or nursing home) as outlined by the patient’s physician.
    2. may include, but are not limited to, appropriate service components such as medical, dental, nursing, social work, home hospice, pharmacy, labo­ratory, physical therapy, occupational therapy, speech, therapy dietetics, homemaker-home health aide service, transportation, chore services, and provision of medical equipment and supplies.
    3. should be reviewed and must be approved by the patient’s physician prior to a final recommendation by the agency to the patient and family.
  9. Believes that a safe environment should exist for the patient in the home setting.
  10. Believes that home health care providers should
    1. demonstrate evidence of ongoing quality assurance activity as shared with an agency medical advisory committee.
    2. be able to offer evidence of continuing education for all agency personnel.
    3. should express willingness to provide necessary care without charge in those instances where payment for services is not possible.
  11. Believes that each home health care agency should have a medical director or medical consultant whose role may include:
    1. Responsibility for planning, coordination and implementation of agency medical-related programs.
    2. Serving as a liaison between professional services staff and referring physi­cians and serving as consultant to agency management and staff.
    3. Responsibility for representing the home care agency in its relationship with other agencies, institutions, the medical profession and the public as may be required.
    4. Coordinating voluntary physician’s input relating to medical policies and protocol.
    5. Coordinating and participating in utilization review, quality assurance and research programs.
    6. Serving as consultant to home care agency administration in the develop­ment and evaluation of agency health service programs.
    7. Representing the agency in its relationship with medical institutions and coordinating/supervising medical student, resident, and fellowship train­ing programs.
    8. Informing the medical community of the agency’s services and programs.
    9. Representing the agency before government and intermediary agencies, as appropriate, in matters pertaining to claim interpretation, regulations and legislation.
  12. Supports expansion of governmental and other third-party coverage for home care services so that efforts to decrease hospital utilization may be continued without reduction in the quality of care.
  13. Believes that home care services can, and do, provide critical support that enables patients to receive cost-effective, quality health care at home despite major functional impairments.
  14. Believes that failure to provide adequate home care services will result in a potential increase in the burden of illness suffered by the frail and disabled.
  15. Believes that while home health care is an expanding and competitive service area and must maintain its fiscal integrity, a) the professional and ethical re­sponsibility, at all levels of participation, is to place the welfare of the patient before personal gain; and b) all participants should be alert to and take an active stance against the misuse of patient trust, unnecessary or monetarily inflated services and/or unethical practices.
  16. Supports efforts
    1. to educate the public about home health care, including types of services, efficacy and cost.
    2. to discourage over or under utilization.
    3. to inform the public (in clear, understandable language) of payment sources, including the benefits and coverage of insurance policies covering home health care.
  17. Recommends that
    1. each patient receive an objective assessment from the physician and home care service of his/her needs, the treatment plan including an estimate of the period of treatment, the type of outcome to expect at the end of the treatment period, and the anticipated cost of services.
    2. if payment for services is denied by a third-party payer, patients should be notified of the denial on a timely basis, with reasons for the denial.
  18. Believes that medical condition, health care needs, and patient preference, in­cluding ability to pay, should take precedence in decision-making regarding the home health care services received and reimbursed.
  19. Supports the concept of an effective quality assessment and quality control program for home health care agencies in Wisconsin. (HOD, 0411)*

*Currently under five-year policy review.