Independence at Home: Medicare’s Return to “Old-Fashioned” House Calls

Medicare officials recently announced that they are returning to the old fashioned idea of medical house calls. CMS is viewing this new experiment, called Independence at Home, as a way to save money and improve care while treating sick, elderly patients in their own homes. Medicare reports that the program saved $25 million overall within its first year.

As of now, there are 14 practices around the country participating in Independence at Home. These house calls are targeted toward patients suffering from complex chronic health problems and disabilities– i.e. the most expensive Medicare beneficiaries. In order to participate, Medicare patients must have been hospitalized and received rehab or home health care in the past year, while also reporting difficulties with at least two daily activities (such as eating or dressing).

In addition to the usual house calls payment, doctors participating in the Independence at Home project are able to receive a bonus if their patients demonstrate at least 5 percent lower total Medicare costs than expected.

Independence at Home is yet another great example of Medicare’s commitment to treating patients the right way by offering personalized and thoughtful proactive care solutions along with chronic care management. With programs like chronic care management and other telehealth solutions, Medicare is able to save money while ensuring exemplary care for their patients.

Dr. Patrick Conway, Chief Medical Officer at CMS and director of Independence at Home, may have said it best:

“House calls go back to the origins of medicine, but in many ways I think this is the next generation.”

Similar to the CCM telehealth program, health care providers participating in the program must be available to the patients 24 hours a day, seven days a week. These providers must also make monthly visits to patients’ homes in order to help detect any new problems or conditions earlier than if they had waited for a routine check-up

According to a study published in 2014 in the Journal of the American Geriatrics Society, primary care that is delivered at home saved around 17 percent in health spending due to a reduction in unnecessary hospitalization or nursing home visits.

However, similar to telehealth virtual visits, these house calls face challenges around reimbursement for providers. Medicare reimbursement for house calls is about the same as an in-person visit, but doesn’t cover any of the physician’s travel expenses or the extra time needed to take care of their complex patients. While Independence at Home is certainly a step in the right direction in regards to an improved care continuum, reimbursement for these services needs to reflect the additional time and effort spent to offer them.

Medicare officials are increasingly realizing that many patients with severe chronic conditions may be unable to care for themselves and lack the mobility to travel to their primary care physicians. Although the goal of the CCM and House Call programs is to improve care in elderly patients at home, these visits are also able to save Medicare money, while providing practices and participating doctors with additional bonuses– a win-win for all those involved.

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