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Next Generation ACO post discharge home visit waiver: Who should be on the team? Print E-mail
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Thursday, 21 December 2017 11:00

As CMS focuses on keeping patients healthy at home, Next Generation ACO primary care physicians are being encouraged to conduct more regular follow-up visits. While the next generation ACO home visit waiver encourages that, the question remains as to who should visit the home and when.

Next generation accountable care organizations like ours are coming up with innovations that can deliver quality care without overextending staff. While an experienced registered nurse is a must for the first visit to a discharged patient, follow-up care can be handled by others.

A paramedic can make sure that in-home equipment is working, that patients have been taking their vitals, and that they're comfortable with their plan of care. If at any point that level of care needs to be elevated, a registered nurse can step in. By matching the medical qualifications to individual needs, patients remain as independent and safe as possible within their home environment while office staff are put to best use.
Paramedics make sense not as a substitute for a registered nurse, but as a complement to that individual’s care. If a patient were to be in distress and called 911, paramedics would respond. They are trained to assess acuity and to contact the primary care physician to determine whether the patient is stable enough to stay at home or must go to the emergency room. In this and similar situations, paramedics are performing the roles for which they are trained while the physician maintains full control over the patient’s care.

For example, a patient who has  congestive heart failure experiences weight gain. Equipment that the paramedic installed in the home notifies the doctor’s cellphone, who then communicates with the patient, advising the person to take a water pill and the paramedic to conduct  a re-evaluation. If the patient is stable, the physician instructs the patient to schedule a follow up office visit the next day.

Does every physician’s  office require  a paramedic? No. Some physicians like to have their own teams during office hours. Others outsource the service. The ultimate benefit is better quality care and better use of people’s training and skills.

Accountable Care Options ( is one of a select group of physician directed organizations organizations accepted into the Medicare Shared Savings Program to improve patient access, medical quality and care coordination in South Florida.

Last Updated on Thursday, 21 December 2017 11:04

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