Medicare study: House calls tailored to frailest patients cut costs by avoiding hospital trips

This StarTribune article by Lauren Neergaard describes how home-based healthcare services to Medicare’s frailest patients with chronic illnesses can improve care while cutting costs.

June 19, 2015 – 2:30 AM

WASHINGTON — An X-ray in the living room. A rapid blood test. A peek into pill bottles and refrigerators. The humble house call can accomplish a lot — and now research suggests that tailoring it to some of Medicare’s frailest patients can improve their care while cutting costs.

Medicare announced Thursday that it saved more than $25 million in the first year of a three-year study to determine the value of home-based primary care for frail seniors with multiple chronic illnesses, by avoiding pricier hospital or emergency room care.

Dr. Patrick Conway, Medicare’s chief medical officer, says the house call delivers “high-touch” coordinated care that allows doctors and nurses to spot brewing problems in a patient’s everyday environment before he or she worsens.

“If we can keep people as healthy as possible and at home, so they only go to the hospital or emergency room when they really need to, that both improves quality and lowers cost,” he said.

House calls are starting to make a comeback amid a rapidly graying population, although they’re still rare. The idea: A doctor or nurse-practitioner, sometimes bringing along a social worker, makes regular visits to frail or homebound patients whose needs are too complex for a typical 15-minute office visit — and who have a hard time even getting to a physician’s office.

“It helps you avoid the emergency situations,” said Naomi Rasmussen, whose 83-year-old father in Portland, Oregon, is part of Medicare’s Independence at Home study.

Her father, stroke survivor Teodor Mal, is prone to frequent infections and unable to tell his wife or daughter whenever he starts to feel ill. Visits to multiple doctors left him so agitated that a good exam was difficult, and just getting him and his wheelchair there took several hours and a special van.