Medicare is in the third year of testing its Independent at Home demonstration project to see if it can improve care and cut costs for some of its more frail patients with house calls. The idea is to test
”...how well a house call approach really works and how to pay for it. About 8,400 frail seniors with multiple chronic conditions — Medicare's most expensive type of patient — are receiving customized home-based primary care from 17 programs around the country,” according to a story at Yahoo! News.
The study was created by The Affordable Care Act and legislation is pending in Congress to extend the project another two years. Meanwhile, Medicare has released an analysis of the project's first year. Results so far?
”...it saved an average of $3,070 per participating beneficiary.”
Meanwhile, in Cincinnati,
”Donna Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor,” reports Kaiser Health News.
“So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.
“'This was so easy,' Miles said.
These two developments, small as the trials are so far, are crucial to the future of elder healthcare and here's why. The 65-plus population the United States has grown dramatically since President Lyndon B. Johnson signed Medicare into law 50 years ago.
In 1965, there were approximately 18 million people age 65 and older in the United States. Today, there are about 41 million and in 2050, there will be more than 88 million.
This is a problem. There are few enough doctors to go around now and it is becoming well known that remaining in our homes, where nearly 90 percent of elders want to be as they age, is less expensive than living in care residences but for some, getting out and around becomes problematic.
Telemedicine and house calls will make remaining home more feasible and can save time (for physicians and patients) and save money too. Not to mention that it makes getting care for people with mobility problems a whole lot easier.
And, house calls these days are a far cry from what I remember as a kid 65 years ago. According to the Yahoo! News report:
”Forget the little black bag of yore. Today's house calls can result in an EKG in the living room, and on-the-spot tests for infections. Providers can use portable X-rays, check medicine bottles to tell if patients are taking their pills, spot tripping hazards, and peek in the kitchen to see if healthy food is on hand.
"'It helps you avoid the emergency situations,' said Naomi Rasmussen, whose 83-year-old father in Portland, Oregon, is part of Medicare's Independence at Home study.”
Videoconference technology has been available for 20 years and I've read dozens of reports over the years of how it will revolutionize healthcare but it has been incredibly slow to get going. Hardly anyone can use it yet.
”...fewer than 1 percent of Medicare beneficiaries use it,” reports Kaiser. “Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. “And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.”
Nevertheless, the innovation is moving forward, if slowly. Many more younger, non-Medicare, patients have access to telemedicine, the number of insurance providers that offer the service is increasing and Medicare is tiptoeing toward change too:
”Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.
“Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals,” reports Yahoo! News.
To me, telemedicine and house calls are such a no brainer – for patients of all ages - that it is frustrating to see how slowly they are developing. It's not like there is any doubt; they ARE going to happen.