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Many Doctors Delay Hospital Discharges Because of Lack of Home Health Services

Cheryl Clark, for HealthLeaders Media, July 1, 2009

Slightly more than half of the doctors who responded to a physician survey in Massachusetts last fall said they kept patients in the hospital longer than necessary because of a lack of access to home health services, according to a new report.

But most of the doctors said they were aware that use of such agencies can safely reduce days of hospitalization and their cost as well as emergency room utilization, an increasing priority in the health reform agenda.

"As physicians see it, greater use of home services can ease costs without compromising quality of care. In today's healthcare environment, that's a winning formula," said Mario Motta, MD, president of the Massachusetts Medical Society.

The society collaborated with the Home Care Alliance of Massachusetts, a nonprofit trade group, to produce the report.

Patricia Kelleher, executive director of the alliance, said there are enough home health agencies around, but "certain kinds of specialized services are in short supply."

"The biggest delay is in getting physical therapists, who in general have been in short supply," she said. "When the patient is ready to be discharged on Monday, but the agency can't get someone to the home until Thursday or Friday, doctors must face a choice between sending patients home with no therapy for two or three days until the service can be found, or keeping them for an extra two or three days in the hospital."

The survey was launched because, according to the society, there is "a dearth of research on physicians' utilization of, and satisfaction with" home health services. Nevertheless, home healthcare can provide an increasing amount of skilled nursing, physical, occupational, and speech-language therapy, and medical social services to people in their homes.

Kelleher added that the survey has implications for the creation of accountable care organizations, in which the silos of hospital care, physician care, and home healthcare are torn apart and the three entities work together to reduce costs and produce better outcomes for patients.

"This report says that at least for Massachusetts, there are very good relationships between physicians and home health agencies that can form a building block for any sort of accountable care organization that we may be envisioning in the future," she said.

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