A neglected area of discussion in home care is the relationship and dissonance between evidence-based research on effective home and community-based interventions, Medicare home health practice, and the Medicare Home Health Prospective Payment System (PPS). PPS is critical because the literature increasingly indicates that the PPS reimbursement framework drives home health agency and practitioner resource allocation and practice decisions. However, the PPS system does not have an evidence-based evaluation process to evaluate the effectiveness and cost-effectiveness of new, or existing, intervention. The article reviews existing evidence-based research on the effectiveness of home-based environmental skills building, counseling, and support group interventions, which benefit patients, caregivers, home health agencies, and Medicare. The article indicates these interventions have never been evaluated, nor are they covered by Medicare. The article asserts the need for such an evaluation process to evaluate intervention cost-effectiveness and related changes in Medicare coverage, eligibility, reimbursement, and outcomes measurement criteria necessary for their adoption.
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