There is increasing interest in the use of telehealth initiatives nationally. Simultaneously, Medicare and other payors are increasingly recognizing that home-based care can be effective, cost-saving, and more person and family centered. To date, opportunities for trainees to learn about home-based care are limited by current funding mechanisms. For example, the primary care exception that allows residents to see patients in clinic and bill medicare, does not apply to the home setting.
At UCSF, Primary care residents and fellows have had opportunities to see patients at home on a very limited basis via the UCSF Division of Geriatrics Care at Home Program. However, this opportunity has been limited by lack of funding for faculty oversight, and most of the visits are done without capability for attendings to precept the visit LIVE. The use of telehealth for trainee education could help provide funding for faculty oversight while also enriching the trainee experience by being able to have "live" precepting. If funded, this opportunity could be avaiable starting with Internal Medicine Residents, Geriatrics Fellows, Nurse Practitioner students, and Palliative Care fellows. If successful, it could also be easily expanded to include other disciplines. For example, live telehealth consults for homebound patients who cannot otherwise see specialists, for example, orthopaedics.
This idea is innovative, interdisciplinary, feasible and has the potential to add a new dimension to our education mission, our trainees needs, and help provide person and family centered care.
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