The Home Health Agency Medical Director Revisited

February 2002

By: Edward Ratner, MD

Do medical organizations have medical leadership? For most organizations, the answer is "yes." Accreditation of hospitals by the Joint Commission on Accreditation of Healthcare Organizations requires the appointment or election of medical staff leaders who provide input into hospital administration. Nursing homes and hospice programs must have medical directors to comply with federal and/or state laws or regulations.

For home health agencies (HHAs), the answer is "maybe." Yet, no reasons exist why HHAs should lack a requirement for medical direction. The clients of HHAs may be as ill as institutionalized patients. Clinical staff of most Medicare-certified HHAs include almost all the disciplines found in a hospital. Interventions provided by HHAs-such as infusion therapy-have often been more complex than those provided in many nursing homes. Furthermore, unlike most nursing homes that serve the elderly almost exclusively, HHAs typically serve a cross-section of age groups; many large agencies serve children, pregnant women, and middle-aged adults with a variety of chronic or acute illnesses or injuries, as well as the elderly.

Roles for HHA medical directors are diverse. At the most basic level, they can provide input on quality of care through review of cases and leadership of a Professional Advisory Committee. Medical directors may be able to make suggestions that improve care plans relative to patients' needs, and their oversight may also improve patterns of care relative to prospective payment reimbursement.

At a second level of commitment, a medical director can improve care by organizing and providing education to HHA staff. Topics may range from review of basic medical issues, such as physical examination skills, to use of new therapies at home (e.g., treatment of deep venous thrombosis with low-molecular-weight heparins).

A third type of involvement is education about home care for referring providers, including physicians, nurse practitioners, physician assistants, nursing home staff, and hospital discharge planners. By working with HHA community representatives (sales staff), medical directors can help expand home health services to populations that might not otherwise be able to stay at home safely. Their presence may also encourage providers to consider shifting referrals to an agency with recognized medical leadership.

At the highest level of involvement, a medical director can be a full member of the management team. An increasing number of physicians have gained management skills through business degrees or coursework offered by medical associations. For example, the American Academy of Home Care Physicians (AAHCP) has offered training and certification specifically for HHA medical directors. In addition to important roles in clinical areas, a medical director on the management team can provide valuable input from a medical perspective into nonclinical issues such as human resources, finance, and information systems.

As models for reimbursement to HHAs stabilize, interest is growing among agency management to have involved medical directors. At its recent annual meeting, a national home health organization with more than 80 branches made a commitment to increasing roles for medical directors in all its branches. As part of its commitment, the company arranged for AAHCP memberships for all of its medical directors.

In recognition of this renewed interest, the AAHCP is recommitting itself to meeting the needs of medical directors of HHAs. One way this will be accomplished is by publishing at least one article in each newsletter on a topic of interest to these individuals. In addition, if adequate interest is expressed, the AAHCP will again offer its medical director training course and certification examination. If interested, call the AAHCP at (410) 676-7966, or send an e-mail to: aahcp@comcast.net.