Benefits of Home Care

CMS' Independence at Home Demonstration project (IAH), now in its third and final year, is designed to test whether home-based care for frail seniors improves quality while lowering costs through fewer ED visits and hospitalizations. While results of the demonstration are not yet known, results from another study on a similar program indicate a high likelihood of success.

The study was led by internal medicine physician and geriatrician Eric De Jonge, co-founder of the Medical House Call Program at MedStar Washington Hospital Center in Washington, D.C., which is participating in IAH.

The study, which was published in the Journal of American Geriatrics Society and which compared the Medicare costs and survival of 722 patients in MedStar's House Call practice to a control group of over 2,000 similar patients selected from Medicare claims data, found that MedStar's house call program reduced total Medicare costs by 17 percent over two years, while lowering hospitalizations by 9 percent and ED visits by 20 percent. The study also found that patients receiving home visits shifted the bulk of their care to primary-care physicians (including geriatricians) vs. higher-cost specialists.

Particularly notable was that the most significant cost savings occurred in the subgroup of very ill, frail patients who met the eligibility requirements for IAH.

"By bringing medical and social services to patients at home, the program helped prevent unnecessary hospitalizations, 911 calls, nursing home placements, and ED admissions," says De Jonge. "IAH has great potential to promote this kind of care in the community and the home."