Medicare Report: Medical House Calls Program Improves Care, Lowers Costs of Treating Frail Elderly at Home

GREAT NECK, NY – Participating in a US Centers for Medicare & Medicaid Services’ (CMS) demonstration project, the North Shore-LIJ Health System’s House Calls program was recently recognized for its success in caring for chronically ill, vulnerable seniors through home-based primary care. In addition to improving outcomes, North Shore-LIJ’s efforts reduced costs, earning the health system $542,232 in incentives.

North Shore-LIJ’s House Calls was one of 17 practices around the country participating in the project, known as Independence at Home, which was established as part of the Affordable Care Act.  The incentive-based payment model showed a savings of more that $25 million in the first year. However CMS awarded incentive payments of $11.7 million to only nine of the 17 participating practices that succeeded in reducing Medicare costs and met designated quality goals for the first year of the demonstration.

CMS reported that Independence at Home participants saved an average of $3,070 per beneficiary, but North Shore-LIJ’s House Calls more than doubled the savings in the cost of care for each participant to $6,388.

“Illness doesn’t stick to a 9-5 schedule, which is why the North Shore-LIJ House Calls program has medical staff available around-the-clock to assist elderly patients during emergencies,” said Kristofer Smith, MD, vice president and medical director of North Shore-LIJ’s Care Solutions, which oversees the health system’s care management organization and operations.  “We know our older, chronically ill patients want to remain comfortably at home, but need services in place to prevent unnecessary emergency department visits or hospitalizations.

“Lessons from the demonstration project show that when you provide a high-intensity care model which is able to respond to patients when they need care, it is possible to achieve the dual aim of improved quality and a reduction in unwanted healthcare services and expenses,” Dr. Smith said.  “This can only be done with a competent and compassionate team of clinicians and staff focused on understanding patient and family goals.”

Patients in the House Calls program can expect a high level of care, similar to that provided in a doctor’s office.  Patient have access to home-based ultrasounds, radiology, EKG, sleep studies, lab work, physical, occupational and speech therapy, as well as intravenous fluids and prescriptions refills.  Clinicians are available to make urgent, same-day visits during the week and are available nights and weekends to answer clinical questions from patients and caregivers, or arrange urgent services. In addition, North Shore-LIJ community paramedic program provides a 24/7 in-person clinical response for patients as needed.

Dr. Smith noted that the North Shore-LIJ’s House Calls program’s quality performance in the first year was better than average, achieving five of six quality measures designated by CMS. On average, Medicare beneficiaries participating in Independence at Home practices have:

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

Dr. Smith said the health system’s cost savings will be reinvested into the project to expand services to more patients in need. Through the demonstration project, North Shore-LIJ’s House Calls program treats 200 patients; nationally the project serves 8,400 seniors.   Independence at Home just completed its third and final year, but legislation is pending in Congress to extend the project another two years.


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