Doctor house calls can save money, study says
Seniors treated at home avoid hospital costs
WASHINGTON — The humble house call is being put to the test to see if it can improve care and cut costs for some of Medicare’s frailest patients — and new data suggest it can.
Medicare revealed Thursday it saved more than $25 million in the first year of a three-year study to determine the value of home-based primary care for frail seniors with multiple chronic illnesses and avoiding pricier hospital or emergency room care.
Dr. Patrick Conway, Medicare’s chief medical officer, said the house call delivers ‘‘high-touch’’ coordinated care that allows doctors and nurses to spot brewing problems in a patient’s everyday environment before he or she worsens.
‘‘If we can keep people as healthy as possible and at home, so they only go to the hospital or emergency room when they really need to, that both improves quality and lowers cost,’’ he said.
House calls are starting to make a comeback amid a rapidly graying population, although they’re still rare. The idea: A doctor or nurse-practitioner, sometimes bringing along a social worker, makes regular visits to frail or homebound patients whose needs are too complex for a typical 15-minute office visit — and who have a hard time even getting to a physician’s office.
Today’s house calls can include high-tech equipment, including administering an EKG and on-the-spot tests for infections. Providers can use portable X-rays, check medicine bottles to tell if patients are taking their pills, spot tripping hazards, and peek in the kitchen to see if healthful food is on hand.
‘‘It helps you avoid the emergency situations,’’ said Naomi Rasmussen, whose 83-year-old father in Portland, Ore., is part of Medicare’s Independence at Home study.
‘‘Patients want to be cared for in their living rooms, not the emergency room,’’ said Senator Edward J. Markey, Democrat of Massachusetts, who wants the project made permanent.
But this kind of care is hard to find, in part because of reimbursement. Medicare paid for more than 2.6 million house call visits in 2013. But add in the travel time, and doctors can see — and get paid for — many more patients in a day in the office than they can see on the road.
Medicare’s Independent at Home demonstration project, now in its third year, tests how well a house call approach really works and how to pay for it.
About 8,400 frail seniors with multiple chronic conditions — Medicare’s most expensive type of patient — are receiving customized home-based primary care from 17 programs around the country.
The incentive for doctors: They could share in any government savings if they also meet enough quality-care goals.
On Thursday, Medicare released its long-awaited analysis of the study’s first year and said the project saved an average of $3,070 per participating beneficiary; Conway said all but five practices generated savings.
Medicare will divide $11.7 million in incentive payments among the nine practices that met enough of the quality requirements for that financial bonus.
The Affordable Care Act created the Medicare study, and legislation is pending in Congress to extend the project another two years.