Home Sweet Home By Dr. Michael Fleming As a family physician I know our nation needs to change how we deliver health care in the U.S. This is where our health care reform debate needs to focus. While so much is good about our health care system, so much could be better. As the health care debate continues, I am concerned that our policy-makers will focus too much on the numbers, and forget that this is about much more than spending: It's about patients; it's about families; it's about care that's widely available and accessible. My journey as a physician has led me to become a passionate advocate for the need for patient-centered care - care delivered how and where each patient needs that care. Our country has an excellent hospital system to handle intensive care, diagnoses and interventions. This system was built up during the 20th century, to care for the needs of our population when our population was younger and the need was acute care. But more and more, as our population ages and our expected life span lengthens our challenge is the everyday care of patients - many with chronic diseases who need nurses, yet are well enough to be at home. And for this expanding population of patients home is where high quality chronic disease management care can be most efficiently and effectively delivered. "In an aging world, with an increase in the number of chronically ill, it's impossible to put all those people in hospital and nursing-home beds. The home will have to play a role," said Philips CEO Gerard Kleisterlee, explaining why his company is focused on developing innovative technologies to deliver cutting edge care in the home. He is not alone. Intel CEO Paul Otellini recently announced a five-year, $250-million dollar alliance with GE to develop home health devices to assist the chronically ill. "Keeping people in their homes addresses the high cost of hospital stays ... Best of all, quality of life is best when people are in their homes, comfortable with their surroundings and surrounded by family," he said. In my experience with home-bound patients, the benefit of being nursed at home, surrounded by family and friends who provide additional nurture, is simple: it's quality of life. Provided the same quality outcome, nearly half the patients polled in a study published by the Archives of Internal Medicine, said that they would prefer home care. But the key issue is more than quality of life. It must be quality of clinical care or, better put, quality chronic care. Where I work, every day our nurses visit 20,000 patients in their homes in 37 states to help manage their chronic illnesses, such as heart disease, diabetes, or Alzheimer's. Our average patient is 82 years old, has to manage 13 medications daily, and is too sick to leave the home without the help of a caregiver. Our admission assessment includes a two-hour one-on-one interaction with the patient and their family. We provide physician-directed care for that patient several times a week. While our mission is to care for those who we treat today, we are constantly investing in new technology and resources to ensure that chronic care management will improve for the patient of tomorrow. I am convinced that home health care is a large part of the solution to one of our nation's biggest challenges: caring for our aging, chronically ill population, while reducing costs and improving patient outcomes. The entire health care industry must transform, including how our nation pays for quality care. President Obama, earlier this year, had proposed cutting as much as $37 billion in Medicare reimbursement to home health services over the next ten years. This is a mistake. These cuts to home health would simply shift the burden to more costly and potentially more perilous facility-based care. HHS Secretary Kathleen Sebelius outlined the challenge, "The number of those 85 and older will increase from 5 million in 2006 to 21 million by 2050, further adding to the strain on individuals, families and the public sector to finance the cost of critical services." Shouldn't our first focus be on improving the quality of care for this aging population? With the health care debate ready to heat up again, Congress and the White House will continue the search for ways to trim spending. But in the area of home health care, cutting costs for cutting sake would erase potential gains. Ask yourself the question that I have asked my patients: Where would you rather be; in a facility, or in your own home? Michael O. Fleming, MD, FAAFP is Chief Medical Officer for Amedisys Home Health Services, a leading provider of home health care and hospice services, with agencies located across the United States and Puerto Rico.