Notes on a talk given at the Annual CFRI Conference by Craig Kephart
Craig Kephart, Registered Respiratory Therapist and Marketing Manager in the Pulmonary Disorders Division of Quantum Health Services, lectured on the use of home care in the treatment and management of cystic fibrosis.
Mr. Kephart astutely pointed out that whether medical care consumers like it or not, "managed care" is redefining health care services in the U.S. The organizations achieve cost reductions by carefully "managing" or controlling all aspects of medical intervention. This can mean negotiating for lower drug prices, lower physician fees, or cutting out what they define as unnecessary treatments. Perhaps most important to the CF community, managed care aims to control hospitalizations which account for the largest share of costs associated with health care.
Routine hospitalizations associated with CF care will likely come under close scrutiny from managed care organizations. Kephart noted most payers had quoted him figures between $18,000-$25,000 per CF hospitalization. With more pressure on treatment centers to reduce costs, home health care becomes a viable alternative.
Mr. Kephart then asked, "What kind of home health care do CF health care consumers consider adequate?" In several focus groups conducted by his company three years ago, he was surprised to learn that CF individuals only looked to home health care for delivery and setup of medical equipment and IV antibiotics. He encouraged the group to stretch the current definition of home health care and consider a provider who specializes in CF treatment, working under the direction of your CF treatment center.
When a comfortable safety net is in place, patients can then manage a large portion of their treatment at home. Some advantages of home care include earlier return to normal living activities, a sense of empowerment and control of your CF, better rest, less exposure to infections, cost savings and better food. Disadvantages of home health care include the temptation to return to normal activities too soon and less assistance with your care which might contribute to exhaustion.
Kephart noted that once a partnership had been formed with a home care professional, the patient can design an ongoing program (under the direction of the physician) that includes the health care provider visiting your home regularly to assess your condition, providing specific training on equipment, and answering questions. This close monitoring might help to detect problems earlier, before they require hospitalization. Finally, he concluded that providers are experts on reimbursement and insurance questions and are there to help you. He urged the group to choose a provider who will work closely with the patient and physician to best meet their individual health care needs.
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