It is well known that aging adults desire to age in place. In order to succeed with this plan, having access to services that come into the home can be vital. Services such as home health, home care and hospice are commonly called upon to support elderly individuals in the home setting. What is not as common is a physician to come to the home. Only about 10% of doctors in the United States are making house calls as of recently. Insurance will only reimburse for it if there’s a medical reason why the patient can’t easily visit an office instead. Who fits the bill? Primarily elderly adults with one or more chronic illness.
Some of these conditions include:
- Alzheimer disease and dementia
- Lung Disease
- Heart Disease
From a patient’s perspective, accessing medical visits in the comfort of home has plenty of benefits. No need to arrange transportation, no waiting in waiting rooms with other sick individuals, no scheduling headaches or missed work for family members. In addition to that, patients enjoy a more personalized experience. The physician in their home is able to give more focused attention. It is also beneficial for the physician to see the patient in their normal environment. If they can see that the patient’s home is lacking cleanliness and organization, it might alert them that something more is going on. Patients can paint a picture of health and stability when they are in a physician office. But when the physician is in their home it is much more difficult to hide problems.
For the payer’s perspective, the focus as of late has been on hospital re-admissions. Research has already shown us that house calls can reduce hospital re-admission rates by as much as 25%. This can account for a considerable cost savings to Medicare. The Independence at Home Medical Practice Demonstration Improvement Act of 2015 was a 3 year test designed to measure the effectiveness of house calls for Medicare beneficiaries with multiple chronic conditions in regards to quality of care and cost reduction. In the third performance year of the demonstration, the Centers for Medicare & Medicaid Services (CMS) found that the participating practices saved approximately 4.7 percent, equating to $16.3 million, an average of $1,431 per beneficiary of their applicable beneficiaries. Five of the 15 practices met the performance thresholds for all six quality measures, which were
- Follow up contact within 48 hours of a hospital admissions, hospital discharge, or emergency department visit;
- Medication reconciliation in the home within 48 hours of a hospital discharge or emergency department visit;
- Annual documentation of patient preferences;
- All-cause hospital re-admissions within 30 days
- Hospital admissions for ambulatory care sensitive conditions;
- Emergency department visits for ambulatory care sensitive conditions.
By 2030, 20% of the US population will be over 65 and approximately 2/3 of them will have one or more chronic condition. Due to this shift, there will be a clear need for more medical providers to provide care in the home setting. Insurance carriers are starting to show a desire to cover more in home services, and healthcare companies are seeing the value in providing care in the home with lower overhead costs and better outcomes. As a result the house call is likely to be making a big comeback in years to come.
About the Author: Pam Reynolds, CMC is the President and co-owner of Allegiance Aging Care Services. Pam has spent almost fifteen years working in senior care including long term care facilities and home health care. Her higher education is in Social Work, and she has been credentialed as both a certified Geriatric Care Manager and Licensed Assisted Living Administrator. Read more about Pam and her team of Aging Care Professionals here.