Affordable Care Act Program Shows Reduced Medical Costs Through House Calls

The Affordable Care Act funded the Shared Savings Program which financially rewards health care organizations for reaching targets for patient care, such as reductions in hospital re-admissions, and thereby reduces plan costs. One of the most compelling projects from this pay-for-performance program has been a resurgence in house calls by doctors to vulnerable Medicare patients. The Wall Street Journal recently featured an article on this phenomena and found the "Independence at Home" Medicare demonstration project has shown a 25 million dollar savings for Medicare in the first year of the program. (1) This article reveals more about how this program works, who participates, and what it might mean for health care plans. Here are the creative health care organizations which elected to participate in this three year initiative (sans the LLC, Inc, or other corporate modifiers): Boston Medical Center, Christiana Health Care Services, Cleveland Clinic Home Care Services, Comprehensive Geriatric Medicine, Doctors Making Housecalls, Housecall Providers, MD2U, Medical House Call Program at Medstar Washington, National House Call Practitioner Group, North Shore Long Island Jewish Health Care, RMED, Schnabel In-Home Care,Virginia Commonwealth University, and Visiting Physicians Association (locations in 4 states). (2)
Awarding Value-Based Payments
As a part of the value-base care initiative, participating practices were able to reduce emergency room re-admission costs by 16.4%. In order to receive a shared savings reward, the organization had to meet the following clinical targets for qualified Medicare patients:

• Have fewer hospital re-admissions within 30 days of discharge
• Have follow-up contact from their provider within 48 hours of a hospital admission, hospital discharge, or emergency department visit
• Have their medications identified by their provider within 48 hours of discharge from the hospital
• Have their preferences documented by their provider
• Use inpatient hospital and emergency department services less for conditions such as diabetes, high blood pressure, asthma, pneumonia, or urinary tract infection.

This pay for performance effort resulted in incentive payments for four group practices and one consortium of health care practices. The top three shared savings recipients for this program were; Visiting Physicians Association capturing the lions share of the compensation, totaling 7.8 million, followed by the Mid-Atlantic Consortium, which includes Medical House Call Program at Medstar, Schnabel In-Home Care, and Virginia Commonwealth,  receiving 1.8 million, and  Portland, Oregon, Home Care Services, getting 1.2 million dollars in incentive pay.(2) It is pretty obvious that the health practices which were exclusively organized to provide home health care had an advantage for the first year of this program, based on the results achieved. However, the other groups may catch up in the three year period, as Medicare has stated it wants to tie 30% of all CMS reimbursements for patient care to incentive plans by 2016 and increase that to 50% by 2018. (3)  I am skeptical these results are possible, nor are all health care organizations going to be able to achieve this outcome, especially smaller practices, so there will be some fall-out on these bold goals. Finally, there is some concern that the focus on health metrics has gotten in the way of patient care, as so much of the clinical day is now devoted to completing forms and reports.

Today's house calls can include portable MRI machines for imaging as well as on-the-spot blood draws and testing, which enable clinicians to gauge the health of especially frail patients more closely. For a vulnerable Medicaid patient who is just out of the hospital, being able to remain at home, and not risk travel or hospital acquired infections could be a plus. However, all you have to do is walk your rounds in today's hospitals to see who the patients are, frail elderly people, who are often without family to look after them, so the house call bonanza won't apply to the entire population.

This article was written by Roberta Winter, a healthcare advocate who has published under the trademark, healthpolicymaven since 2007, and may be shared virally. For more straight talk on health care programs and policy you can follow me on twitter at:.https://twitter.com/healthpolicymav
 
Roberta Winter is the author of: Unraveling U.S. Healthcare-A Personal Guide, which may be found at http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972





(1) Laura Landro, "How House Calls Cut Medical Costs", Wall Street Journal, September 27, 2015
http://www.wsj.com/articles/how-house-calls-can-cut-medical-costs-1443407612
(2) Innovation Projects, Centers for Medicare and Medicaid, Independence at Home, Year One Results  http://innovation.cms.gov/Files/x/iah-yroneresults.pdf
(3) Centers for Medicare and Medicaid, Media Release, June 18, 2015
 https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-06-18.html