Home care past, present, and future: opportunities and challenges in a managed care environment

This article describes the history of Medicare-based home care and the changing requirements of the home care industry as the reimbursement models continue to evolve. Medicare-based home care was once seen as an ancillary service of the hospitals. Now, with the advent of managed care, home care provides new options and opportunities and is facing new challenges at both the local and the national levels. Current proposals in Washington, such as bundling, co-pays, and a Prospective Payment System, will have farreaching effects on the industry. This article discusses the various reimbursement models, including Medicaid, Medicare HMOs, managed care, and capitation, and identifies key areas and opportunities for home care in the future.