Dr. Daniel Oates, a geriatrician at the Boston Medical Center, is bringing back an age-old practice by making house calls to elderly patients. Oates believes that house calls provide more consistent and personalized care, possibly even reducing the risk of a hospital visit and delaying the necessity to move to a senior living facility. That’s because by making house calls, physicians can monitor the care of patients who otherwise may not leave their homes to seek regular medical care, according to an article in Boston.com.
House calls: A money-saver or major expense?
The program has caught the attention of the Centers for Medicare and Medicaid Services, which is now looking at the Boston Medical Center as well as 15 other providers offering similar programs to determine if the practice is something that could be used to reduce healthcare costs under the Affordable Care Act.
On the contrary, programs like that run by the Boston Medical Center aren’t common because of the cost. It costs about $3,000 per year for each patient enrolled in the program, according to David Kornetsky, administrative director of geriatric services at Boston Medical Center, and Medicare only covers approximately half of those costs. In the case of the Boston Medical Center, the facility subsidizes the rest, although other cash-strapped providers may struggle to do the same. Currently, Boston’s program has about 575 patients enrolled in the service it has been offering since 1875. Overall, “Home care accounts for about 1 percent of all Medicare billing for ‘evaluation and management services,’ essentially time spent talking with doctors, versus tests or procedures, said Gary Swartz, associate executive director of the American Academy of Home Care Physicians.
Providers under pressure to provide better care for elderly and chronically ill
Boston.com points out that beginning in the fall, providers will be penalized for having high rates of re-admissions within 30 days for conditions such as heart failure or heart attacks. Because acute care is so expensive, a shift to a model that rewards providers for conducting better preventative care can reduce these unnecessary re-admissions and costly treatments by taking a proactive approach in the case of chronic illness.
National pilot program to test cost effectiveness
There’s a national pilot program underway, Independence at Home, designed to evaluate costs and quality of care with home care models like BMC’s. This large-scale test will evaluate up to 10,000 patients and is designed to put to rest conflicting study results from past years that didn’t consistently demonstrate a cost savings. (Most recent studies have, however, shown a clear savings benefit.) The Boston Medical Center is enrolling about 100 patients who meet the following criteria:
- Have traditional Medicare coverage.
- Have had a recent hospitalization.
- Have a chronic illness.
- Have functional limitations.
The trial is set to last three years, with a minimum average requirement of 200 enrolled patients throughout the study. And if the BMC program saves more than 11 percent, the Centers for Medicare and Medicaid services will pass some of those savings on to the hospital.The quality measures to be tracked include:
- Patient satisfaction.
- Frequency of emergency room visits.
- Frequency of hospitalizations for preventable conditions.
- How providers feel about their work.
The program will include measures such as social worker visits to monitor home safety (identifying problems such as loose throw rugs or poor lighting), determine whether patients are safe in the care of their family members or other caregivers, and even help sort through medications and help with accurate dosing. Overall, the care provided is more personalized and gives providers greater insight into patient compliance and other concerns that may not be obvious on an office visit. According to Swartz, if the program is successful, Congressional action would be required to expand beyond 10,000 patients, but he hopes that promising results will encourage other providers to revisit house calls.