House calls can save on elder care, study says
Washington – — Ten or 12 times a year, Beatrice Adams’ daughter would race her frail mother to the emergency room for high blood pressure or pain from a list of chronic illnesses.
Then Adams found a doctor who makes house calls, and the 89-year-old hasn’t needed ER care in the nearly two years since.
“I’m not a wimpy female,” Adams said. “I have only 11 years to make 100, and I’m going to make it.”
The old-fashioned house call is starting to make a comeback as part of an effort to improve care for some of Medicare’s most frail and expensive patients.
While it may sound like a luxury, bringing team-based primary care into the homes of patients like Adams, according to a new study, actually could save Medicare money by keeping them from needing pricier specialty or hospital care.
“They have a lifeline,” explained Dr. Eric De Jonge, a co-founder of the medical house call program at MedStar Washington Hospital Center, who led the study.
Such elder care is rare, but is growing. Medicare paid for 2.8 million house calls in 2012, the latest data available, compared with 1.5 million about a decade ago.
De Jonge and colleagues compared the cost and survival of 722 patients enrolled in their house call practice in recent years with Medicare claims records of 2,161 similarly ill patients who never received home medical care.
Death rates between these two groups were similar. But over a two-year period, total Medicare costs were 17 percent lower for the house-call patients, or an average savings of about $4,200 per person per year, the group reported last month in the Journal of the American Geriatrics Society. They used more primary care but used less hospital, specialty and nursing home care.
Now Medicare has begun a major demonstration project designed to test how well the house-call approach really works — one that for the first time will allow participating providers to share in any government savings that result if they also meet quality-care requirements.
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