Pediatric home care. A cost benefit and cost effectiveness update.
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Child↗
Biomedical subjects
W Balinsky
Publications and source records attributed to W Balinsky.
Home drug infusion therapy. A literature update.
This paper is a literature review and update of home drug infusion therapy (HDIT) in the United States. It concentrates on cost-effectiveness studies of parenteral antibiotic therapy administered in an outpatient setting. This update is timely because Medicare and other payors are under the pressure of cost containment with respect to this modality. Additionally, managed care is redefining reimbursement programs, which will affect HDIT in the future.
Cost Savings↗
Home Health Management Services, Inc. cluster care program: an update.
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Cost Savings↗
High-tech home care.
The past 20-25 years have seen innovations in equipment and drugs that have allowed infusion services to move from institutions to the home. The home care industry moved into the HDIT field, considering this a natural direction in which to develop. High-tech home care is now a substantial aspect of the industry.
Anti-Bacterial Agents↗
Home care's integration into managed care.
As hospitals and managed care organizations strive to reduce costs and maintain quality, home care agencies will need to intervene and care for an increasing number of patients. Therefore, agencies will need to be knowledgeable about and competitive under the same reimbursement mechanisms and risks to which hospitals and physicians are forced to respond.
Cost Control↗
The New York City shared aide program (cluster care): a model for the future.
In order to combat rapidly escalating home health care costs, New York City and State have inaugurated a "shared aide" program in which home attendant "teams," as opposed to individual aides, serve large groups of elderly clients who live in close proximity (e.g., at senior housing sites), thus reducing the aide-to-client ratio. Using New York City as a model, this paper examines the premises underlying the shared aide concept--the program's objectives, methodology, advantages/disadvantages to home care workers and clients, and, most importantly, its potential, if implemented nationwide, for cost containment and a corresponding substantial reduction in the Medicaid budget.
Aged↗
The shared aide program. The cluster care experience.
Traditional home care services use a one-on-one caregiver-to-client approach in time blocks. In urban setting caregivers may cross each other's paths as aides from several agencies each visit several patients in one building. Cluster care services use a team approach by tasks, consolidating visits and providing a more coordinated, cost-effective approach to services.
Allied Health Personnel↗
Cost-effectiveness of outpatient parenteral antibiotics: a review of the literature.
The results of studies completed on parenteral antibiotic therapy administered in an outpatient setting are reviewed. Although they varied in both size and sophistication, the studies all found that when patients and their families were carefully screened, outpatient therapy was a cost-effective, safe method of administering intravenous antibiotics. The methods used to compare the costs of inpatient and outpatient intravenous antibiotic therapy varied widely. Only direct costs were included in the early comparisons of inpatient and outpatient therapy, whereas the more recent studies included both direct and indirect costs and benefits. All studies found cost savings in the outpatient setting. Unfortunately, very few elderly patients were included because of a Medicare requirement that intravenous antibiotic therapy be administered or supervised by a physician. However, beginning in 1990, the Medicare Catastrophic Coverage Act of 1988 will cover intravenous drugs administered at home. Thus, it will be possible to study applicability of this therapy for the elderly population.
Anti-Bacterial Agents↗
The impact of DRGs on the health care industry.
The impact of Medicare's prospective payment system on hospitals and home care agencies includes significant changes in patient and service mix and quantity as well as rapid entrance of hospitals and proprietary organizations into the home care industry. As a result, many opportunities and challenges confront hospitals and other health care providers.
Centers for Medicare and Medicaid Services, U.S.↗
The future role of the physician in home health care.
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Forecasting↗
Neighbors helping neighbors. Bronx Community Home Care.
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Community Health Services↗
A comparative analysis of agencies providing home health services.
This study analyzed hospital-based and community-based home health care agencies by means of a small purposive comparative case analysis. The results revealed that hospital-based agencies were different from community-based agencies in terms of agency organization, management, personnel, revenues and expenditures. The voluntary community-based agencies examined were free-standing, single purpose agencies providing the lion's share of direct services to the home health care population. The hospital-based agencies (and public community-based agencies) examined were components of larger organizational structures. Hospital-based agencies concentrate their activities on case finding, case management, and the coordination of patient services, as well as the direct provision of medical therapy and social services. The type of home health agency, community-based or hospital-based, or those examined has been found to define this agency's primary function. This also determined its personnel/staffing pattern and consequently, to a large extent, its expenditure pattern. Additionally, most revenues for certified home health agencies are derived from cost-based reimbursement methodologies of public funding sources. Therefore, agency surpluses or shortages are primarily associated with personnel expenditures and therefore with agency mission and agency type. This study concludes with a discussion of some trends and events that are likely to affect the home health care agencies of the future.
Community Health Services↗
Proprietary and voluntary home care agency evolution: the emergence of a new entity.
The objective of this paper is to document that the delivery of home care services and the corresponding ways in which they are marketed are evolving in both proprietary and voluntary providers. This evolution is producing the emergency of a new entity. In order to examine the present state, it is necessary to review the general history of the development of both voluntary (not-for-profit) and proprietary home health services. Then, an analysis of present conditions will show that these two forms of ownership are changing in ways that are making them more alike than different. This situation is leading to more intense competition for an expanding and diverse mix of home services. Program content and corresponding marketing techniques have crossed the industry's traditional lines blending into a wide array of services being offered by both voluntary and proprietary organizations. Despite their many shared goals and objectives, home care agencies still differ in their underlying philosophy which is based at least in part on their past.
Aged↗
Home health care: a comparative analysis of hospital-based and community-based agency patients.
This study analyzed the patient-type and service-mix of hospital-based and community-based home care agencies. The results of this analysis revealed that hospital-based agency patients were different than community-based agency patients, in terms of the above mentioned variables; and that these differences were statistically significant. Specifically, hospital-based agency patients were older, were more limited in their functional ability, received a higher intensity of care, and utilized a greater proportion of therapeutic services. Furthermore, a higher percentage of hospital-based agency patients were in an acute care facility prior to home care; had cancer and circulatory disorders as their primary diagnosis; and had Medicare as their primary source of payment. This study concludes with recommendations with respect to future planning and administration of home care services.
Activities of Daily Living↗
A review of the research on general health status indexes.
During the mid-1960's, recognition of the spiraling cost of health care motivated Congress to enact several major pieces of legislation designed to underwrite efforts to improve the delivery of health services. The increased level of federal fiscal participation in the health service system has forced greater consciousness of the need for better accountability of the effectiveness and efficiency of the allocation of the dollar. Demands were articulated for precision tools which could evaluate the imput to output linkage between need and response; however, the tools were nascent and had limited applicability. Cost-effectiveness and cost-benefit analysis are two procedures that have since been applied with varying levels of success. A third tool, also developed as an outgrowth of the desire for a more accurate characterization of the planning concerns of an efficient/effective health service system, is the general health status index. The purpose of this article is to provide the reader with a comprehensive review of the literature on general health status indexes. Common objectives and constraints are presented, as well as a discussion of the expanding role of general health status indexes.
Activities of Daily Living↗
Pediatric home care: reimbursement and cost benefit analysis.
Home care has been described as the fastest growing component of personal health care spending, and pediatric home care as the fastest growing segment of the home care field. Because of the continued progress in pediatric medicine and advances in technology, a growing population of children with complex chronic and terminal conditions can be cared for at home. A growing subspecialty in pediatric health care is delivering services for infants and children with HIV infection or AIDS and those born to mothers addicted to drugs or alcohol. This article describes the reimbursement and cost-benefit issues surrounding pediatric home health care, with particular attention to the HIV/AIDS pediatric population.
Acquired Immunodeficiency Syndrome↗
Pediatric end-stage renal disease: incidence, management, and prevention.
Although pediatric end-stage renal disease affects a small number of children, it is a serious and growing health problem in the United States. In the past decade, the incidence of the disease has increased steadily in all racial groups. However, poor and minority children are disproportionately affected. Recent research results make it clear that appropriate prenatal and pediatric care can reduce the incidence of this complex and expensive-to-treat condition.
Child↗
Reimbursement for outpatient parenteral antibiotic therapy: update.
Reimbursement policies of third-party payers, including Medicare, reflect a variety of coverage patterns. For a limited group of Medicare patients who are, in Medicare terms, confined to home and require skilled and intermittent care, Medicare Part A covers home care services deemed medically necessary by a physician. Medical equipment and supplies may be included under this coverage. Medicare Part B covers physician services, laboratory tests, and drugs used by out-patients. The latter must be administered directly by a physician or by an employee of a physician with direct supervision by a physician. These restrictions have, in general, prevented reimbursement by Medicare for iv antibiotic therapy in the home. Medicaid, Blue Cross/Blue Shield, various commercial insurers, and health maintenance organizations usually cover iv antibiotics, but in many cases prior approval is necessary for coverage.
Ambulatory Care↗