Home based medical care for frail elders reduces Medicare costs by 17%

MedStar Washington Hospital Center geriatricians found that when medical care for frail elders with advanced illness shifts to the home, total Medicare costs were reduced by 17 percent during a two-year period. A new study published in the Journal of American Geriatrics Society (JAGS) underscores the value of home-based primary care for America's aging seniors.

K. Eric De Jonge, MD, co-founder of the Medical House Call program at the Hospital Center and his colleagues, conducted the study that compared Medicare costs and survival of 722 patients enrolled in the hospital Medical House Call practice, to a control group of 2,161 patients selected from Medicare claims data. The study analyzed total costs, death rates, patterns of hospital admissions and types of doctor visits. It concluded that home-based primary care saved an average of $8,477 per patient during two years.

The study also revealed there were nine percent fewer hospitalizations, 20 percent fewer emergency department visits, 27 percent fewer skilled nursing facility stays and 23 percent fewer specialist visits. The data revealed high death rates that were similar in both groups.

"Because this group of patients is the most expensive in the medical system, even fractional savings can make a significant dent in health care costs," said Dr. De Jonge. "This study confirms home-based medical care is an effective and lower-cost model of care for these high-risk elders."

After recognizing the health challenges ill elders faced in the community, MedStar Washington Hospital Center created the Medical House Call program in 1999. An interdisciplinary team of physicians and nurse practitioners provide 24-hour-a-day, 7-day-a week on-call telephone coverage, and make frequent visits to patients at home and follow them in the hospital. Social workers coordinate psychosocial and supportive services. Clinicians make same day urgent house calls, to prevent avoidable hospitalizations and other costly complications.

The study findings suggest there is value in implementing this house call model nationwide. The Hospital Center is one of 18 national sites that are part of an ongoing Medicare demonstration program called Independence at Home (IAH), which is probing the impact of home house call teams on patient care and costs. If successful, IAH would share overall savings with the teams. The study results support the need to expand home-based primary care and the IAH concept throughout the United States.

"Promoting the health and dignity of elders by helping them remain in their home is hard work, but we can expand these services, if the payment system supports growth of such mobile care teams," added Dr. De Jonge.