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BMC will put house calls to the test

Program may be a money-saver

Boston Medical Center will participate in a national program to test whether providing frail seniors with health care in their homes keeps them out of the hospital or nursing homes and saves money.

The Centers for Medicare & Medicaid Services plans to track up to 10,000 Medicare enrollees who receive house calls from doctors and nurses, and it will share potential savings with the 16 participating organizations.

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Boston Medical Center has provided health care in people’s homes since 1875, with an emphasis on serving the elderly in the past three decades, said David Kornetsky, administrative director of geriatric services. Teams of doctors, nurses, and Boston University medical students now make house calls to about 600 seniors.

The new program, called Independence at Home, will enroll 200 people in Boston who have multiple chronic conditions, have been hospitalizedrecently, and are limited in their ability to perform some daily functions, such as feeding themselves or walking.

The agency will tally the total cost of caring for those patients, wherever they are treated, and compare it to the cost of treating similar patients not enrolled in the program. The Boston Medical Center program must shave more than 11 percent off total costs before the agency will share savings with the hospital.

Kornetsky could not provide budget details yesterday, but said Medicare typically does not cover costs of the house calls, so the hospital provides significant support for the program. But Kornetsky said he believes the program saves money by preventing more costly care.

“We believe in our bones that it does work, that it is cost-effective,’’ Kornetsky said. “This is really an opportunity to show that it is.’’

Clare Wohlgemuth, geriatric services nursing director, has a metaphor to explain why home visits are effective. Physicians see a snapshot of their patients’ lives during an office visit, she said. She sees the video.

Wohlgemuth said she recently persuaded a woman she cares for in Roxbury to keep a bed on the first floor of her home. The patient, impaired by a spinal cord condition, used to scoot down the stairs from her second floor bedroom each morning on her behind, a habit that put her at risk for a fall and wore her out.

“I know she does that, because I’ve seen her do it,’’ Wohlgemuth said. “If she was coming to see me in my office practice, I would never know that.’’

Wohlgemuth said home visits allow her to support family caregivers, explain a patient’s medication schedule, watch for worrisome drug interactions, and provide regular care to people who may otherwise skip doctor visits because they cannot physically make the trip to an office.

Independence at Home was created under the Affordable Care Act by an amendment sponsored by US Representative Edward J. Markey, a Malden Democrat.

The program is “bringing the house calls of yesteryear into the 21st century,’’ Markey said in an e-mailed statement. Keeping seniors in their homes, he said, “not only saves money, but also increases the peace of mind of patients in their twilight years.’’

If Independence at Home is successful, expanding it would require further action from Congress.

Keeping people at home and providing community-based service has been a focus of state and national health officials. Earlier this month, US Health and Human Services Secretary Kathleen Sebelius announced the creation of the Administration for Community Living to oversee offices that serve people who are elderly or have disabilities.

The Centers for Medicare & Medicaid Services also released a plan Thursday to allow states to receive more federal matching money for services provided in the homes of people on Medicaid, the state-based program for the poor and disabled, and who would otherwise require a nursing home or other residential facility.

Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy.
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