My nephew is a first year resident in Internal Medicine. Our conversations are few and far between because he is working many hours per week. I enjoy the times we get to talk because as a home health agency owner I love hearing his perspective from a “gate keepers” point of view.

When I spoke with him yesterday he was troubled by the number of face to face attestations he was being asked to complete on individuals that he did not think were homebound. He stated, “They have blood pressure issues, but look healthy otherwise.”

Dee Kornetti and I took this opportunity to arm him with questions to ask the home health agency to see why they feel the patient is homebound. We encouraged him to send the face to face back to the agency with a question written on the attestation asking why the patient was homebound.

We then encouraged him to do a ride along, or visit an agency, to become more familiar with home care. He informed us he had done those during medical school and it was eye opening – having the opportunity to shadow a physical therapist doing a home visit to evaluate needs for a patient prior to discharge from an inpatient facility. He will have the opportunity in the near future, as part of his residency, to participate in a home-based primary care rotation as a practicing physician.Indoing this, he stated he will be anxious to look for ways to communicate with agencies and disposition their orders, in a way that does not feel disingenuous while maintaining a level of conscientiousness related to “spending Medicare dollars.”

The conversation with my nephew got me thinking.

How many doctors are facing this issue and what are we doing as an industry to educate them on the challenges our patients face? Do we let them know, as Dee offered to my nephew yesterday, that the trip to the doctor is a snap shot of a patient’s life? Patient’s often only get dressed on days they have to visit the doctor. And, a visit to the physician often results in a limitation, or inability of the patient, to participate in any further meaningful activities once they return home.How many of our patients live alone? Being able to tolerate a visit to the doctor and nothing else, in the course of a day surely does not represent a level of “community independence” in such patients.

Do we arm our referring doctor’s with the questions, or clinical assessment information that will help determine a patient’s home bound status?

Better yet, do we encourage our doctors to query agencies that seem to have a very broad and erroneous interpretation of homebound status?

Our doctors are doing the best they can to stem the tide of fraudulent behaviors inhome health today. We need to be partner with them to make sure that medical care in the home is provided every time it is needed, and not when it isn’t. To do this, increasing the amount and type of communications we seek from our referral physicians is integral.