Care at Home Less Expensive than Hospital Care
Published on Jul 27, 2015
In 2012, the CMS announced an ambitious project, Independence At Home, to tame the rising costs of caring for one of the costliest patient populations: the frail elderly. Now, three years later, results from 17 providers are in, and they are positive. More than half (53%) have been given bonuses ranging from $275,000 to $2.9 million for shrinking Medicare costs and improving patient care.
According to a study published in the Journal of the American Geriatrics Society, MedStar Washington (D.C.) Hospital Center, a 926-bed hospital reports significant savings and better clinical outcomes for frail elderly by providing all the care the patients needed at home instead of at the hospital. According to the article, the participants in this project anticipted spending $5,076 per beneficiary per month, but instead spent $4,060. As a result, MedStar will share a $1.8 million bonus payment from CMS along with two other providers, Penn Medicine and Virginia Commonwealth University Medical Center. The three providers form the Mid-Atlantic Consortium (MAC), which received the second-highest bonus awarded.
MedStar began their House Call program in 1999. K. Eric De Jonge, MD, and George Taler, MD, co-founded the hospital-based, team approach that cares for frail and elderly patients in the D.C. area. "When we started this program, we began a new geriatrics division and talked to the CEO and CMO … and they gave us 2–3 years to break even," says De Jonge. "What became clear is the need. We got 20 new patients per month without marketing and it grew rapidly. Eligibility for the program are frail elderly with multiple chronic illnesses who have a high risk of hospitalization and socioeconimic needs. Patients must be over 65, have some form of insurance, live within the 9 zip codes served by the hospital and have trouble getting out of the home. Two teams take care of 300 House Calls' patients. Each team includes 10 people: Two MDs, two NPs, two social workers, two office coordination and an LPN and business manager who float between the two teams.
Each Independence at Home site had to meet six quality measures in order to receive a portion of Medicare's shared savings. The bonus depends on how many measures were met. MedStar says each provider in the MAC met all six:
- Reduce 30-day readmissions
- Provider follow-up within 48 hours of hospital admission
- Medication reconciliation within 48 hours of hospital discharge
- Advance care directives documented
- Reduce ED admissions for treatable chronic conditions
- Reduce hospital admissions for treatable chronic conditions