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House calls reduce rehospitalizations, but not costs, study shows

Article

House calls can reduce rehospitalizations and boost satisfaction for high-risk patients, but they don't do much to reduce costs, according to a study published in the American Journal of Managed Care.

House calls can reduce rehospitalizations and boost satisfaction for high-risk patients, but they don’t do much to reduce costs, according to a study published in the American Journal of Managed Care.

Although home-care patients in the study used hospital services at a significantly lower rate than the control group, medical costs for home-care patient didn’t show a similar reduction when adjusted for demographics and health conditions.

The absence of cost reduction may be explained by the types of patients who were included in the study. Patients in the study experienced fewer medical needs than expected, which may have decreased potential savings opportunities, researchers said.

Nonetheless, the study showed a “significant” difference in the percentage of patients who used at least one hospital inpatient day in the year following study enrollment: 26% for the home-care group and 37% for the control group.

Further, home-care patients reported, on average, that satisfaction with their care grew 18% after 6 months, whereas that number held steady for the control group.

The study was conducted in 2008, with about 300 patients from southern California split roughly evenly between the home-care and standard-care groups. Patients included in the study were chronically ill and judged to be at a high risk for hospitalization.

Home-care physicians who took part in the study were available to visit 24 hours a day, 7 days a week, and also made regularly scheduled home visits as medically appropriate, according to the study.

Even though house calls didn’t create any cost savings in the study, their ability to cut down on hospital readmissions could make them an attractive tool to health organizations.

That’s because the Centers for Medicare and Medicaid Services later this year will begin penalizing hospitals up to 1% of Medicare reimbursements for high readmission rates.

More than 2,200 hospitals are expected to be penalized under the new program, which was put in place by the Affordable Care Act (ACA), Kaiser Health News reported last month.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills.

The ACA also included a provision to set up a pilot program called the Independence at Home (IAH) Demonstration, which aims to test whether providing primary care services at home improves care for Medicare beneficiaries with multiple chronic conditions.

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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health