House calls: A sound way to reduce hospital readmissions, care costs

Older and chronically ill patients are always in danger of hospitalizations and readmissions, driving up healthcare costs. But an old-fashioned concept--house calls--could tame such patients, according to the Wall Street Journal.

What is known as "home-based primary care" can improve outcomes for patients and drive down the costs of their care, according to the article. In one pilot project in the District of Columbia, the program led to costs that were 17 percent lower than those for a control group--an average of nearly $8,500 less per enrollees over two years, according to a 2014 study published in the Journal of the American Geriatrics Society.

The house calls were also ramped up immediately following a hospital discharge, including a medication check within 48 hours of returning home. 

A Centers for Medicare & Medicaid Services (CMS) pilot project called Independence at Home that served 17 medical practices and more than 8,400 patients saved $25 million in its first year. A shared savings model provides incentives for providers to participate.

House calls are "a very expensive proposition in the fee-for-service world," Robert Sowislo, executive vice president for governmental affairs at U.S. Medical Management, told the Wall Street Journal. "But having the shared savings model makes it more economically feasible to expand across the U.S."

Some standalone hospitals have started house call programs on their own.  For example, Valley Hospital in Ridgewood, New Jersey, uses a combination of medical teams and remote monitoring technology to keep readmissions down among chronically ill patients with conditions such as congestive heart failure. 

In Minnesota, North Memorial Health System uses a team of paramedics to make house calls to try and keep admissions down. The team focuses specifically on patients that have had nine or more emergency room visits in any calendar year.

To learn more:
- read the Wall Street Journal article
- here's the study (.pdf)

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