House Calls Cut Costs and Save Lives

How The Independence at Home Program Works

House Calls Medicare
House calls improve quality of care for Medicare beneficiaries. Justin Horrocks/E+/Getty Images

In a perfect world, people would go see the doctor before they would ever need hospital care. There would be preventive care measures in place to decrease the risk for someone's chronic illness from getting out of control. The Centers for Medicare and Medicaid Services (CMS) has set out to improve care while decreasing emergency room visits and hospital admissions.

Where Modern Medicine Fails the Elderly

In 2010, more than one-half of Americans had at least two chronic illnesses with that number increasing to more than 63 percent for those over 65 years old and up to 83 percent for those over 85.

 The trouble is not everyone can get the care they need in the doctor's office.

For those who are frail or bed-bound, those who are likely to need medical care the most, it may be physically challenging to even leave their home. For others, the complexity of their many conditions may warrant longer than the usual 15 to 20-minute office visit. The doctor may need them to come in several times to have enough time to address all the issues.

In the real world, physicians struggle to fit more and more patients into their busy schedules. When patients cannot be seen, patients can find themselves in the emergency room trying to get urgent care, care that is much more expensive than what could be offered in the outpatient setting.

Return of the House Call

With the passage of the Affordable Care Act (Obamacare) in 2010, millions of previously uninsured Americans now have access to health care. Strapped for time, doctors are trying to see more patients in less time to meet that demand.

That leaves less time for house calls. In 2013, only 13 percent of family doctors did a house call in any given week and only 3 percent did two house calls a week.

The Affordable Care Act helped to implement the Independence at Home program to incentivize doctors to make more house calls. Doctors who save money for Medicare while improving the quality of care would share in financial bonuses.

The three-year pilot program enrolled 17 different practices across the country to deliver home-based care to Medicare beneficiaries who had multiple chronic illnesses. To enroll, each practice had to administer home care to at least 200 Medicare patients via a doctor or nurse-practitioner. The program as a whole cared for more than 8,400 Medicare beneficiaries.

Benefits of House Calls  

Independence at Home showed positive results in its first year, saving $3,070 per Medicare beneficiary and $25 million overall. Of the 17 participating practices, 12 saved money for their patients, 9 met criteria to earn financial bonuses and all of them improved quality of care for patients in at least three of six categories. Only four practices met the goals for all six quality measures.

More importantly, the lives of these patients were impacted for the better. There were fewer hospital readmissions, improved follow-up after hospital stays, better overview of medications and overall decreased use of hospital services for chronic care conditions.

This is not the first time house calls have been shown to reduce costs and improve care. A 2014 study in The Journal of the American Geriatrics Society reviewed a house call program caring for 722 patients over two years. Savings per patient averaged more than $4,200 per year with fewer hospitalizations and emergency room visits by 9 percent and 10 percent respectively.

House calls make a difference. As the Independence at Home pilot program continues for another two years, look to find more doctors at a home near you.

Sources:

Centers for Medicare and Medicaid Services. Affordable Care Act payment model saves more than $25 million in first performance year. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-18.html. Published June 18, 2015.

Centers for Medicare and Medicaid Services. Chronic Conditions Among Medicare Beneficiaries, Chartbook: 2012 Edition. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf.

De Jong KE, Jamshed N, Gilden D,Kubisiak J,Bruce SR, Taler G. Effects of Home-Based Primary Care on Medicare Costs in High-Risk Elders. Journal of the American Geriatrics Society. October 2014, 62(10): 1825-1831. http://onlinelibrary.wiley.com/doi/10.1111/jgs.12974/full.

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