If Reimbursing for Visits, a Business will Naturally Increase Visits

Results are in for Year 2 of ACOs
Medicare Seeks Models that Achieve the Triple Aim

At a recent VNAA National Public Policy Leadership Conference, Jim Pyles, one of the proponents of the Independence at Home Project, said, “If you reimburse for visits, a business is going to push making more visits. If you reimburse for episodes, a business will naturally push for getting more episodes.” That was his reasoning behind the ACO model not bringing in as much savings as originally anticipated. However, in a report just released and published in Modern Health, the results are coming in for the Accountable Care Organizations that were set up as one of the trial Medicare models to see if the triple aim can be achieved: lower costs, better patient care and a healthier population.

The Pioneer ACOs showed improvements in three key areas: financial, quality of care, and patient experience. However, the model has not really changed, only collaboration to accomplish the results. The Independence at Home Project, on the other hand, targets that 10% of the population that is the heavy user of Medicare dollars. The following is taken directly from the website explaining the Independence at Home Model, but it really does explain the project and its intent very well:

“There are 3-4 million seniors now living with multiple chronic illnesses such as diabetes, lung and heart disease who are too ill or disabled to easily visit their physician when they need care. These seniors, representing approximately 10% of Medicare beneficiaries, account for two thirds of Medicare’s expenditures.

These seniors are typically unable to access a primary care physician’s office for needed care, instead of going to the ER or being hospitalized. These are the patients who place the largest burden on Medicare, and this problem isn’t going away. The number of people with multiple chronic illnesses will grow to 6-8 million by 2025.

The Solution
The quickest way to control health costs is by addressing these highest cost patients first. House calls are a solution to the rising costs of helping home-limited patients with multiple chronic conditions. At $1,500 per ER visit, we can show that the cost of 10 house calls more than offsets the expense of an avoidable ER visit. Savings are even greater for avoided hospitalizations.

Improved Care for Patients, Savings for Medicare
Home-based primary care programs have the potential to save 20-40% on Medicare’s most expensive patients by bringing them care in their homes. IAH provides for care coordination across all care settings. Providers are also accountable for good care and reduced cost. Overall this is a win for patients, their families, and Medicare!”

We all know that the boomers are getting older, and as this “pig in a python” population cohort gets older, the system is going to have to change to accommodate the needs. Paying privately for care is one option, but more people cannot afford to cover their long-term care costs than can. It is encouraging to see that we are, as a health care delivery system, looking at innovative and effective new ways to use home care as a low cost alternative and a viable option.