Quality gains, cost reductions make strong case for the modern house call
Nearly every day a claim is made that something will make our lives better, healthier, easier. And while many of these claims are interesting, and some become game changers, most are hype.
Nowhere is this phenomenon more prominent than in medicine. Science has produced what only a few decades ago were considered miracles—treatments, pharmaceuticals, diagnostics and surgeries, that have made, for example, many cancers curable or treatable as chronic diseases. Having a stroke or a heart attack is no longer a death sentence. The list goes on.
However, as medicine continues to make huge strides with technology as its partner, we often forget that physicians remain at the center of medicine, and patients are at the center of physician practices. This brings us to an old practice that is becoming new again: the house call.
While traditional house calls never disappeared, their frequency dwindled because they didn’t fit into the modern fee-for-service model. However, our interest never disappeared. We have always known their benefit, which, combined with the current focus on value over volume, has caused policymakers to look again at an old but good idea.
In June, the CMS announced that after just one year of its three-year Independence at Home Demonstration (IHD), participating physician practices saved an average of $3,070 per beneficiary—while delivering high-quality patient care in the home.
U.S. Medical Management and its affiliate, Visiting Physicians Association (an IHD participant), represented 25% of the patient care in the demonstration. Participating practices showed high performance on many quality and cost measures, including a 16.4% reduction in expected costs, and reductions in all-cause 30-day readmissions, in-hospital admissions and emergency department visits for ambulatory care-sensitive conditions.
For family physicians like Dr. Thomas Cornwell, this is great but not unexpected news. As the leader of the Home Centered Care Institute in Wheaton, Ill., he has made 32,000 house calls to more than 4,000 patients through his house-call practice. Cornwell calls this Affordable Care Act initiative a part of the perfect storm that is driving an increased demand for modern house calls. Unlike traditional home care, this new version of the house call is based on a medical home; house calls are not a supplement.
Also driving this perfect storm is a quickly aging baby-boomer population, the Medicare and Medicaid fiscal crisis, healthcare reforms, including the CMS’ goal to reduce hospital readmissions, and the shift from volumebased to value-based payment.
As a result, house-call physicians are part of an effort to get Congress to pass legislation to move this homecare demonstration into a new housecall benefit similar to how the Program of All-Inclusive Care for the Elderly, or PACE, program became a new benefit. PACE is designed to keep people age 55 and older out of nursing homes by providing communitybased care and services.
This would mean more shared cost-savings opportunities. Therefore, more providers would be incentivized to offer home care. And because only about 15% of the people in the U.S. who need home care are receiving it, there is plenty of potential for growth.
An October 2014 study in the Journal of the American Geriatrics Society analyzed the Veterans Health Administration’s Home-Based Primary Care Program, which started over 20 years ago and serves more than 30,000 veterans. The study found:
A 24% reduction in total healthcare costs under the program (2002 data), which amounted to an annual savings of more than $10 million.
The HBPC provided four times more primary home care versus traditional home health, but still produced a 63% reduction in hospital costs, and an 87% drop in nursing home costs.
2007 data found a 59% reduction in hospital days, an 89% reduction in nursing-home days and a 21% reduction in 30-day readmissions.
All of these results have piqued the interest of major medical networks looking to better serve their patients while reducing readmissions and costs. And this has family physicians excited about the future of the house call. “Those who have been the pioneers of house calls have known about its value for years,” Cornwell said.
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