Medical House Calls Program Improves Care, Lowers Costs of Treating Frail Elderly Patients at Home

During a home visit, Dr. Karen Abrashkin, a physician at Northwell Health’s House Calls, gives an exam to her 92 year-old patient Dorothy Shannon of Long Island.

For the second consecutive year, Northwell Health’s House Calls program has been  acknowledged by the Centers for Medicare & Medicaid Services (CMS) for its success in caring for chronically ill, frail seniors through home-based primary care as part of a federal demonstration project. In addition to improving health outcomes, Northwell’s clinicians reduced costs during the program’s second year by $6,816 per patient per year for total savings to Medicare of $1,641,825.  This was the second highest savings performance among the demonstration sites.  After accounting for Medicare withholds, Northwell earned $874,151 in incentive payments.

Northwell Health’s House Calls was one of 15 practices around the country participating in the demonstration project known as Independence at Home, which was established as part of the Affordable Care Act.  CMS analyzed performance data from practices from June 2013 to May 2014, the most recent period for which information is available.  However, CMS awarded incentive payments of $5.7 million to only seven of the 15 participating practices that succeeded in reducing Medicare costs and met quality goals for the second year of the program.  Northwell’s House Calls was the only program in New York State to receive incentive payments from CMS.

During the second year of the demonstration project, Northwell’s House Calls practice provided care to 357 patients in Nassau and Suffolk counties as well as Queens in New York City.  Independence at Home’s targeted spending for each beneficiary, which is based on a regional formula, was $3,276.  Northwell’s practice spent $2,708 delivering care to each patient, a cost savings of 17.4 percent.

“We know our older, chronically ill patients want to live at home as long as possible,” said Kristofer Smith, MD, senior vice president of population health management and medical director of the organization’s care management entity, called Northwell’s Health Solutions.  “Programs like Independence at Home are complex to build.  Our early success relies on providing high-quality care that is highly reliable, giving patients access to health care providers whenever needed.

“Our House Calls practice delivers patient-centered care to our frail elderly patients that improve outcomes, reduces the cost of care, and alleviates pain and suffering for patients in the community by preventing unnecessary emergency department visits or hospitalizations,” Dr. Smith said.

Patients in the House Calls program receive coordinated care, similar to treatment and referrals they would receive from a primary care physician, such as ultrasounds, radiology, electrocardiogram (EKG), sleep studies, lab work, physical exams, occupational and speech therapy, social work services, as well as intravenous fluids and prescription refills.  Physicians, nurse practitioners, and other clinicians are available for urgent, same-day visits during the week.  The House Calls team also is accessible 24/7 to answer clinical questions from patients and caregivers or arrange urgent services. 

“The success of our program is rooted in communication, caring, time spent in patients’ homes and our ability to build trust with patients, family members and caregivers,” said Joseph Milano, MD, medical director of Northwell’s House Calls program.  “Clinicians and patients become partners in caring and are focused on the same treatment goals.”

Dr. Milano noted that House Calls’ strong performance in the demonstration project was achieved through teamwork with other caregivers across the healthcare organization.  “Collaboration between our Northwell health care partners involved in our patients’ care is critical,” he said, adding, “Our team approach strives to achieve the right level of care, at the right time, in the right place of care.”  Key services include geriatrics and palliative care medicine, outpatient geriatrics, full-time hospitalists, home care, hospice care, a clinical call center and paramedics who provide a 24/7 in-person clinical response, assessment and treatment for patients as needed.

Under the Independence at Home Demonstration, participating practices must meet the performance measures for at least three of the six quality measures in order to qualify for the incentive payment.

Dr. Smith said Northwell Health’s House Calls program’s quality performance in the second year was excellent, achieving benchmarks in all six quality measures designated by CMS.  The six measures are:

  • Follow up contact within 48 hours of a hospital admission, hospital discharge, and emergency department visit;
  • Medication reconciliation in the home within 48 hours of a hospital discharge and emergency department visit;
  • Annual documentation of patient preferences;
  • All-cause hospital readmissions within 30 days;
  • Hospital admissions for ambulatory care sensitive conditions; and
  • Emergency department visits for ambulatory care sensitive conditions.

Dr. Smith said the cost-savings achieved in the federal project will be reinvested to expand House Calls’ services to more patients in need.  Independence at Home is in its fourth year.  In July, the US Senate introduced legislation -- the Independence at Home Act -- to convert the innovative home-based primary care demonstration project into a permanent, national Medicare Program.