Study: Home-Based Care Leads to Less Pressure on Medicare

Home-based primary care (HBPC) reduces Medicare costs for ill seniors, a new report finds. 

A HBPC model led to 17% lower total Medicare costs over two years based on the study’s elderly participants, according to the report “Effects of Home- Based Primary Care on Medicare Costs in High-Risk Elders,” published in the The Journal of American Geriatrics Society (JAGS).

The cases examined in the report had lower costs for hospital care, physician fees and skilled nursing facility (SNF) care. Specifically, the cases had 9% fewer hospitalizations, 10% fewer Emergency Department (ED) visits, 27% fewer SNF stays and 23% fewer specialist visits. 

Recently, the Social Security and Medicare Boards of Trustees annual review of Medicare found the program is projected to have enough to cover its obligations until 2030, 13 years later than was projected in the last report issued prior to passage of the Affordable Care Act.

The Centers for Medicare & Medicaid Services (CMS) estimates that about 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare about $18 billion in 2013, based on the most recent data.

The HBPC study evaluated 722 HBPC cases and more than 2,000 controls who were matched for sex, age, race, Medicare buy-in status and more. Mean age was 83.7 for HBPC participants and 82 for control participants. 

HBPC recipients were eligible to participate in the study if they enrolled in MedStar, Washington Hospital Center’s HBPC program, during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland and Pennsylvania.

“The results of this study are consistent with those of other studies that suggest that a house call model can reduce costs and produce solid clinical outcomes for high-risk elders,” report authors say in a news release. “Given the move toward more value-based payments, providers will need to create such innovative models that provide better-quality, lower-cost care to elders with severe chronic illness.”

The Partnership for Quality Home Health Care links the study’s findings to that of the success seen with the the U.S. Department of Veterans Affairs’ (VA) HBPC program, operating 150 HBPC sites nationwide, noting that it too “has reduced costs.”

“VA data indicate the HBPC has reduced inpatient hospital days by 62% and long term care days by 88%, resulting in a 24% decrease in total healthcare costs for HBPC participants,” The Partnership says in the same release.

The VA HBPC program provides comprehensive disease management and patient care to veterans with chronic conditions.

“Existing programs have shown the potential for lower costs with good outcomes when patients receive home health for both post-acute and primary care,” says Steven H. Landers, MD, MPH, president and CEO of the VNA Health Group. “This most recent JAGS study contributes necessary analyses to a growing body of research that confirms what health professionals and patients have understood for some time now – that the appropriate use of home health has great potential for making our nation’s healthcare system more efficient, more effective and more patient-focused.”

Written by Cassandra Dowell

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