Medical House Calls program improves care, reduces costs of treating elderly patients at home

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Dr. Karen Abrashkin, medical director of Northwell’s House Calls program, greets her patient Rose Katz, 83, in her home. (Photo courtesy of Northwell Health)

For the third consecutive year, Northwell Health’s House Calls program has been recognized by the Centers for Medicare & Medicaid Services (CMS) for its success in caring for chronically ill, frail seniors through home-based primary care as part of a federal demonstration project. In addition to improving health outcomes, Northwell’s clinicians reduced costs during the program’s third year by $8,784 per patient per year for a total savings to Medicare of $2,447,838.

This was the third highest savings performance among the demonstration sites. After accounting for Medicare withholds, Northwell earned $1,280,686 in incentive payments, the only such program in New York State to receive incentive payments from CMS.

Northwell Health’s House Calls was one of 15 practices around the country participating in the demonstration project known as Independence at Home, which was established as part of the Affordable Care Act. CMS analyzed performance data from practices from June 1, 2014 through May 31, 2015, the most recent period for which information is available. CMS awarded a total of $7.2 million in incentive payments to the seven of the 15 participating practices that succeeded in reducing Medicare costs and met quality goals.

During the third year of the demonstration project, Northwell’s House Calls practice provided care to 396 patients in Nassau and Suffolk counties as well as Queens in New York City. Independence at Home’s targeted spending for each beneficiary, which is based on a regional formula, was $3,486. Northwell’s practice spent $2,754 delivering care to each patient, a cost savings of 21 percent.

“We know our older, chronically ill patients want to receive medical care at home as long as possible,” said Dr. Karen Abrashkin, medical director of Northwell Health House Calls. “Programs like Independence at Home involve a large interdisciplinary team working in concert to deliver individualized patient care. We are dedicated to providing high-quality care and giving patients access to the appropriate health care provided at the right time.”

Patients in the House Calls program receive coordinated care, similar to treatment and referrals they would receive from a primary care physician, such as ultrasounds, radiology, electrocardiogram (EKG), sleep studies, lab work, physical exams, occupational and speech therapy, social work services, as well as intravenous fluids and prescription refills. Physicians, nurse practitioners and other clinicians are available for urgent, same-day visits during the week. The House Calls team also is accessible 24/7 to answer clinical questions from patients and caregivers, or arrange urgent services. Finally, in partnership with our Center for Emergency Medical Services, House Calls developed a nationally recognized community paramedic program capable of brining highly trained clinicians to the home in under 30 minutes.

“Our House Calls practice allows us the time to really get to know our patients and their goals for treatment,” Abrashkin said. “We are focused on delivering patient-centered care that improves outcomes, reduces the cost of care, and alleviates pain and suffering for patients in the community by preventing unnecessary emergency department visits or hospitalizations.”

Abrashkin noted that House Calls’ strong performance in the demonstration project was achieved through teamwork with other programs across the health system, including partnerships with the system’s nurse Clinical Call Center, Home Health Care Agency, Hospice and Physician Access Services.

Under the Independence at Home Demonstration project, participating practices must meet the performance measures for at least three of the six quality measures in order to qualify for the incentive payment.

Abrashkin said Northwell’s House Calls program’s quality performance in the third year was excellent, achieving benchmarks in all six quality measures designated by CMS. The six measures are:

  • Follow up contact within 48 hours of a hospital admission, hospital discharge, and emergency department visit;
  • Medication reconciliation in the home within 48 hours of a hospital discharge and emergency department visit;
  • Annual documentation of patient preferences;
  • All-cause hospital readmissions within 30 days;
  • Hospital admissions for ambulatory care sensitive conditions; and
  • Emergency department visits for ambulatory care sensitive conditions.

Abrashkin said the cost-savings achieved in the federal project will be reinvested to expand House Calls’ services to more patients in need. Independence at Home is now in its sixth year.

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