Reform Opens Door to Return of the House Call

While a provision of national health reform calls for increased house calls for some of the nation’s sickest patients by 2012, a pair of congressmen say the initiative is needed now and want progress by the end of the year.

The provision at the heart of the matter is the “Independence at Home,” a program allowing some of the sickest Medicare beneficiaries – those suffering from heart failure, Alzheimer’s’ Disease, diabetes and other ailments – to receive their care not in a doctor’s office, but in their own home.

Rep. Edward J. Markey (D-Mass.) and Sen. Ron Wyden (D-Ore.), who authored the IAH demonstration program as part of the Patient Protection and Affordable Care Act, are asking CMS to implement the program as soon as possible prior to the reform law’s January 2012 deadline. The pair want the program implemented in the next six months.

“We believe strongly that there are numerous reasons for implementing the IAH program sooner rather than later,” Markey and Wyden told CMS in a letter. “There is also strong evidence that the clinical house call model at the heart of the IAH program works and can be implemented quickly.”

Similar local programs exist, allowing teams of health care providers to coordinate care in the comfort of patients’ homes. But the federal program comes with an interesting hitch. Aimed at reducing health care costs by reducing the risk of these patients traveling, providers who agree to participate in the program only get reimbursed if their care results in a savings of at least 5 percent.

Markey and Wyden are proposing that the program provide for an 80 percent/20 percent split of savings for providers who go beyond that 5 percent threshold during the three-year federal program. “Such a division of savings is intended to address the economic risk providers assume to participate in the IAH demonstration program, as providers are accountable for achieving at least 5 percent savings for caring for Medicare beneficiaries participating in the IAH program as compared to the cost of caring for these patients in the absence of the IAH program,” the pair wrote in a letter to CMS.

The program – and the congressmen’s call for immediate action – has the support of groups includingthe American Academy of Home Care Physicians and the American Association of People with Disabilities, who say better care can come at home, benefiting the patient and medical costs as the program is expected to essentially pay for itself through the savings.

Some skeptics say care is better provided in a medical setting and have some issue with proving savings through the IAH program. Others accuse Markey and Wyden of playing politics with the program amid reform’s sweeping changes, including those affecting seniors.

But in a time when the medical landscape is changing, when “medical cost” is the buzzword of insurers justifying double-digit rate hikes and everyone searching for a way to reduce the cost of care, why not go back to the future, so to speak? Why not make house calls – for those that need it the most – the norm rather than the exception?

Sometimes to go forward, you have to look back.