That's a lot of money over the years, especially for a program that organizers suspected actually saved money by improving preventative care for its most vulnerable and — usually most costly — senior patients. The program charges about $100 per house call and pays doctors and other staff modestly compared to other health professionals in the hospital. It largely depends on philanthropic grants of up to $300,000, funding from MedStar as well as modest donations from individuals.
"We didn't get any financial rewards for it," said Dr. Eric De Jonge, director of geriatrics and co-founder of the program largely supported through donations.
But for the first time last week, the program actually got a check back.
The Centers for Medicare & Medicaid Services gave back share savings to the tune of $1 million as the result of a multi-year experiment to reduce the cost of caring for chronically ill seniors by incentivizing hospitals to offer home-based medical care to its sickest elderly patients. Elderly patients who need home-based primary care represent 5 percent of the patient population, but account for nearly 50 percent of Medicare’s budget, De Jonge said. MedStar was one of 15 sites around the country that took part in the demonstration. "It's changing how Medicare pays us," De Jonge said.
The Medical House Call program, in partnership with MedStar Institute for Innovation, has served as one of 15 national sites for the Medicare experiment since 2012. MedStar teamed up with house-call programs from Virginia Commonwealth University and the University of Pennsylvania to form the Mid-Atlantic Consortium, which collectively reduced per capita Medicare costs by 20 percent and received $1.8 million in shared savings from Medicare in the first year of the program. That works out to about $12,000 in savings per patient.
Nationally, CMS found participants saved more than $25 million in the demonstration’s first performance year — or an average of $3,070 per participating patient — and awarded incentive payments of $11.7 million to nine participating practices responsible for reducing the spending while meeting quality metrics. "These results support what most Americans already want — that chronically ill patients can be better taken care of in their own homes. This is a great common sense way for Medicare beneficiaries to get better quality care with smarter spending from Medicare," said CMS Acting Administrator Andy Slavitt.
In the first year of that experiment, MedStar's program was able to reduce readmissions within 30 days, get patients a follow-up contact from their providers within 48 hours of a hospital admission, have their medications identified by their provider within 48 hours of discharge from the hospital, have their preferences documented by their provider and use inpatient hospital and emergency department services less for conditions such as diabetes, high blood pressure, asthma, pneumonia and urinary tract infections.
The secret sauce is simply having teams available for offering medical feedback and care when necessary — 24 hours a day, seven days a week — to reduce unnecessary visits to the emergency department. "We avoid 911 calls," De Jonge said.
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