Abstract
The purpose of this study was to conduct a scoping review of the available service delivery models related to home-based fall prevention programs led by rehabilitation professionals and to describe the path to launching one such program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). Topics of review included: Medicare and private billing structures available for current prevention programs and traditional rehabilitation, the Affordable Care Act and its application to reimbursement of preventive services and direct access care models, and a comparative review of CMS' Patient Driven Group Model (PDGM) home health benefit and Medicare Part B billing and reimbursement. Additionally, a path to launch one prevention-focused program, HOP-UP-PT, is described. There is emerging evidence that upstreaming fall prevention programs can help reduce falls and have money-saving downstream effects. A reimbursement model for this type of programming must be established in order ensure long-term sustainability. Although there is evidence that home-based prevention programs such as HOP-UP-PT can reduce falls and fall-risk metrics among an older adult population, there is not a clear and sustainable payment pathway, which limits proliferation of similar programs. Therefore, this preventative care model which has emerging evidence of cost savings will require reimbursement restructuring beyond what is available with existing payment models.