Medicare pilot project revives house calls as cost-cutting strategy

Jeff Rowe
Medicare pilot project revives house calls as cost-cutting strategy

In what might be called a "Back to the Future-style" experiment, Medicare officials have apparently figured out one way to save money and improve care: house calls.

According to an article from Kaiser Health News, a pilot project launched two years ago is based on the idea that, if done well and paid for appropriately, house calls might be an effective way of treating very sick, elderly patients while also allowing them to live at home.

"House calls go back to the origins of medicine, but in many ways I think this is the next generation," said Dr. Patrick Conway, who heads the Center for Medicare and Medicaid Innovation and oversees the project, called Independence at Home.    

"In the first year of the experiment," the article notes, "Housecall Providers of Portland, Oregon, which had been operating at a loss, saved Medicare an average of almost $13,600 for each patient in the pilot project. Its share of the savings was $1.2 million. The house calls practice at MedStar Washington Hospital in Washington, D.C., cut the cost of care an average of $12,000 per patient."

Overall, Medicare reported savings of $25 million in the pilot's first year. The program targets patients with complicated chronic health problems and disabilities who are among the most expensive Medicare beneficiaries. Even with those challenges, "a key study, published in 2014 in the Journal of the American Geriatrics Society, found that primary care delivered at home to Medicare patients saved 17 percent in health spending by reducing their need to go to the hospital or nursing home."

Despite the program's success, many doctors remain wary of reviving the "old ways." For one thing, the criteria for joining the program are extensive. "Under the law creating the program, practices could join only if they make house calls to at least 200 patients with traditional Medicare who have been hospitalized and received rehab or other home health care within the past year. These patients also must have trouble with at least two activities of daily living, such as dressing or eating (and ) the health care providers must be available 24 hours a day, seven days a week."

Moreover, the program's reimbursement for house calls is about the same as an office visit and doesn't cover travel time or the extra time needed to take care of complex patients. It's not enough to convince most doctors "to leave the relatively comfortable controlled environment of an office or hospital to do this sort of work," said Dr. William Zafirau, medical director for Cleveland Clinic's house calls program in Ohio, which has 200 patients in the Medicare pilot and plans to add 150 more.

Nonetheless, the success of the program thus far is clear. In the Oregon case, for example, "hospital admissions dropped so significantly that (the director) expanded the transition team to serve house calls patients who were not part of the pilot program when they were hospitalized."