Evaluating alternatives for providing home health-care services.

Alternatives for providing home health-care services (HHC) are discussed. An institution may provide HHC services for a variety of reasons including economic incentives, physician requests, consumer demands, and a desire to provide continuity of care. In planning an HHC program, data should be collected to provide a reliable estimate for potential HHC referrals. Demographic and reimbursement information on potential referrals should also be collected. Six basic HHC functions--patients screening and selection, patient training, product compounding, supply distribution, clinical management, and reimbursement--are described. The level of institutional participation in each of these functions is determined by the number of patients who require the services, the availability of resources, and the interest and expertise of the hospital staff. Alternatives for carrying out these responsibilities are discussed. The process for screening potential HHC providers is described. The value of competitive bidding for HHC services is emphasized, and specific data for the bid request and contract development are presented. Hospitals can provide HHC services through a variety of mechanisms ranging from the total delegation of HHC responsibilities to an external organization to the independent assumption of all HHC functions by the hospital. Hospital pharmacists can play a leadership role in HHC program development.