House calls increase satisfaction and cut hospital admissions among elderly
■ Researchers say house calls didn’t save money compared with other models of care, but that could be because of the population treated.
A house call program may not always reduce health care costs in treating older adults with numerous chronic conditions, but there may be other benefits, according to the August American Journal of Managed Care (link).
“The problem is not the model but most likely the way we selected the people,” said Susan Enguidanos, MPH, PhD, one of the authors and an assistant professor at the University of Southern California in Los Angeles. “We need to better select the population based on illness and need.”
House calls are one of many possibilities being considered to reduce medical costs within health system reform. The paper looked at 156 elderly patients randomized to a house call program run by HealthCare Partners. These patients were compared with 142 who were not in the program. Enguidanos is a consultant with HealthCare Partners, based in Torrance, Calif., and operates medical groups and physician networks in California, Florida and Nevada.
The majority of the other authors are employees of HealthCare Partners, which is one of the Centers for Medicare & Medicaid Services’ pioneer ACOs and takes part in an ACO pilot project for people with coverage through Anthem Blue Cross. CMS also is sponsoring the Independence at Home demonstration project, which is investigating whether house calls will save money for Medicare beneficiaries. HealthCare Partners is not a participant.
Total medical costs per patient in the house call program were $2,000 lower than for those getting usual care, but the difference disappeared when researchers ran the numbers through a statistical regression model adjusted for race, age, sex and medical conditions. This means expected costs per individual patient didn’t actually change.
However, satisfaction with medical services went up 18% for the house call patients during a six-month period but held steady in the control group. After 12 months, hospitalizations decreased in the house call group, although this did not reduce total health care costs because of the intensity of services received in the home. More than 37% of those in the usual care group were hospitalized compared with only 26% of the house call patients.
Other studies have found that house calls reduce medical costs, particularly for patients at the end of their lives. But researchers believe that money was not saved for this population because the older adults had chronic conditions such as Alzheimer’s disease that required nursing and other supportive services but not that much medical care. The house call program included monthly visits by physicians, nurse practitioners, nurse care managers and social workers. A home care physician also was available for a visit or telephone consultation 24 hours a day, seven days a week.
“This model might be too intensive for them,” Enguidanos said.
The authors believe money may be saved over a longer period or for patients with greater medical needs. Accountable care organizations looking to use house calls to cut expenses may need to choose participating patients carefully to achieve the desired results.
The house call program is not part of HealthCare Partners’ ACO, but it may become a cost-saving strategy for some patients, Enguidanos said. The reduction in hospital admissions may make house calls worthwhile even without lowering total health care costs. Hospitals with high readmission rates will see a 1% reduction in Medicare pay in the 2013 program year, which begins Oct. 1.