Are you totally confused by the issue of health care reform and the spin that the politicians are putting on it? You should be.

Depending on your media source, you may have heard that you will be meeting with a panel that will arbitrarily decide if you are to live or die, sort of like the crowd watching the gladiators in the Roman arenas. Or that your out-of-pocket costs for medical care will make life meaningless anyway.

The major debates center on women's health issues, rationing of care, and the much-maligned pay for health care workers to provide end-of-life counseling.

One health care reform issue that seems to be absent from serious discussion has to do with Medicare reimbursing health care professionals for providing health care coordination.

According to Dan Tobin, M.D., an authority on family caregiving problems, Medicare's fee-for-service structure focuses on acute care and virtually neglects serious chronic illness coordination.

"Major studies," says Tobin, "have found out that if physicians initiate care coordination, families are better able to plan for aging in place, with fewer hospitalizations and nursing home stays."

When patients and family caregivers understand their doctors' recommendations, coordinate medical and nonmedical home care, and plan for the progression of an illness, there can be significant reductions in hospitalizations and institutional transfers, as well as improved quality of life.

Coordination of services, both medical and community support, would without question save millions of those precious Medicare dollars. This is especially true when the coordination begins in the outpatient setting at the time of a diagnosis of a serious and chronic illness such as congestive heart failure, Alzheimer's disease, kidney or other major organ failure, or Parkinson's disease.

The goals of coordination of care are straightforward. What needs to happen to lessen the progression of the disease and even reverse it where possible? What kind of home adaptations need to be made to increase the safety of the dwelling? What nutrition support is needed? Who can provide transportation, or monitor medication, or oversee the general activities of daily living?

This coordination is a process that begins with a solid diagnosis followed by a thorough assessment of strengths and needs - personal, social, financial, spiritual and environmental. From this assessment a plan can be developed - a plan that is dynamic and individualized enough to be altered as the situation progresses either way.

Care coordination supports the family, or friend, caregiving system. It provides the individuals involved with ongoing direction and a plan that allows them to persevere without endangering their own health.

This seems like such a money-saving, common-sense approach, with research-measured outcomes. But Medicare, and thus other insurance providers, do not reimburse for these services - at least not yet.

If health care is to be reformed in a meaningful way for Medicare-eligible people with serious chronic diseases, the system will have to pay up front for care coordination. It is efficient, effective and supportive of the natural caregivers, and it is a proven way to save money.

Barbara Quirk is a Madison geriatric nurse practitioner. Tandbquirk@aol.com

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