Home-based primary care reduces Medicare payments for frail elders

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.

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.

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