Asthma Program Helps Patients, But May Hurt Hospitals

At the same time, Homer said, asthma disproportionately affects children in the most vulnerable populations. As a result, Medicaid and health care payers need to make sure that the preventive asthma care will be encouraged.

"What you'd want to do is create financial incentives that would at least not penalize people for doing the right thing," he said.

Lisa Mannix, the manager for state government relations at Children's, said that some of the problems stem from the asthma initiative involving places and people not typically considered part of health care.

"In the current, traditional health care system, those kinds of workers are not providers that have been able to bill or get any payment for their service," she said.

"I think there's generally interest," she said of conversations with Medicaid providers about payment for the program. But, "months have gone by and it just hasn't come to fruition."

These types of programs have gotten some attention. America's Health Insurance Plans has given grants in the past to promising interventions for treating asthma.

Mannix and Homer agree that some form of bundling -- where payments are based on the patient rather than hospital visits -- will likely be necessary to overcome the problems programs like the Community Asthma Initiative ostensibly face.

"It's a lot more expensive than what it would be to provide care up front," said Mannix. "At the end of the day, it is Medicaid or other insurers who reap the benefit of not having to pay for these urgent care visits."

The View From New York

Desire La Tempa, who runs the program at Woodhull Medical Center in Brooklyn, N.Y., said her program has seen similar results to those at Children's in Boston.

She said that after interventions at home, patients had a 52 percent reduction in ER visits and a 78 percent reduction in hospitalizations for asthma.

But one issue she has not seen as much is with Medicaid. Payments are done by state, and in New York, she said, Medicare will cover a home visit to help a patient with asthma. While La Tempa said she does not know the exact reason for the difference in policy in Massachusetts, she noted that New York's extremely high asthma rate may have something to do with it.

"If you check the amount of money these patients cost to Medicaid, it's really high," she said. "That really costs Medicaid much more than providing a patient with these resources."

But she said that hospitals may benefit from these programs in more ways than just helping patients.

For one thing, La Tempa said, patients who go to the ER may return if they do not get an intervention. And in those cases its not clear Medicaid will pay extra for the same problem.

But hospitals that provide the home visit service may see benefits the way other businesses do, she said.

While interventions have reduced ER visits and hospitalizations, La Tempa said one type of hospital visit was growing: planned visits to the clinic to help with asthma management, which doubled between 2008 and 2009.

When patients are able to control their condition with the hospital's help, she said, they will spread the word. And in areas with plenty of asthma, more patients may want that same level of care.

"They're going to bring their family and their friends as well," said La Tempa.

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