Home-based primary care reduces Medicare payments for frail elders

JEN followed frail elders receiving home-based primary care through Washington (DC) Hospital Center and a matched control population for an average of two years. Individuals receiving the home-based primary care had lower Medicare payments overall and for hospital and skilled nursing facility services specifically. They had higher rates of home health and general practice visits but fewer visits to specialists. Rates of mortality and time to death were similar for the cases and controls. The study used the JEN Frailty Index, which is based on diagnoses related comorbidity and functional impairment, to control for frailty in the case and control cohorts.

Citation:
Effects of home-based primary care on Medicare costs in high-risk elders. De Jonge KE, Jamshed N, Gilden D, Kubisiak J, Bruce SR, Taler G. J Am Geriatr Soc. 2014 Oct;62(10):1825-31. Epub 2014 Jul 18.

Abstract:
In a matched control study of Medicare enrollees, frail elders receiving home based primary care through the MedStar program at Washington Hospital Center and a matched control population were followed for an average of two years. Mean age was 83.7 for cases and 82.0 for controls (P < .001). A majority of both groups was female (77%) and African American (90%). During a mean 2-year follow-up, in univariate analysis, cases had lower Medicare ($44,455 vs $50,977, P = .01), hospital ($17,805 vs $22,096, P = .003), and skilled nursing facility care ($4,821 vs $6,098, P = .001) costs, and higher home health ($6,579 vs $4,169; P < .001) and hospice ($3,144 vs. $1,505; P = .005) costs. Cases had 23% fewer subspecialist visits (P = .001) and 105% more generalist visits (P < .001). In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary (P = .003) over 2 years of follow-up. There was no difference between cases and controls in mortality (40% vs 36%, hazard ratio = 1.06, P = .44) or in average time to death (16.2 vs 16.8 months, P = .30). The availability of home based primary care reduced Medicare payments for frail elders. The study used the JEN Frailty Index to risk-adjust the population based on specific diagnoses related to functional impairment.

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