Chronically ill Medicare beneficiaries in a home setting are receiving high-quality primary care services because of the Independence at Home Demonstration, a patient-centered model that supports providers in caring for patients who are homebound, according to a news release from the Centers for Medicare and Medicaid Services. The Aug. 9 news release stated IAHD participants saved Medicare more than $10 million — an average of $1,010 per beneficiary — while delivering higher quality care.
“These results continue to support what most patients already want — the ability to have high-quality care in the home setting,” Patrick Conway, MD, CMS, acting deputy administrator and chief medical officer, said in the release.
“According to the CMS analysis, all 15 [participating] practices improved quality from the first performance year in at least two of the six quality measures for the demonstration,” the news release stated. “Four practices met the performance measures for all six quality measures.”
Improved care for beneficiaries has been demonstrated in several ways, including: having follow-up with their providers within 48 hours of hospital admission, discharge or visit to the ED; having fewer readmissions within 30 days; having medication identified within 48 hours of discharge; documenting preferences to their providers; and using inpatient services and the ED less for diabetes, high blood pressure, asthma, pneumonia or UTIs.
Physicians and nurse practitioners in medical practices participating in IAHD tailor their home visits based on the needs of beneficiaries who have multiple chronic conditions and functional limitations, according to the CMS website. “The demonstration also tests whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction, and lead to better health for beneficiaries and lower costs to Medicare,” the website stated. “The Independence at Home Demonstration is authorized by Section 3024 of the Affordable Care Act.”
The demonstration, which began in 2012, was initially authorized for a three-year period. It has been extended through September 2017 by the Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015.
More homebound adults can be expected in the future, according to the June 2015 Geriatric Nursing article, “Homebound older adults: Prevalence, characteristics, healthcare utilization and quality of care” by Shirley Musich, PhD; Shaohung S. Wang, PhD; Kevin Hawkins, PhD; and Charlotte S. Yeh, MD.
“Homebound older adult populations with mobility restrictions comprised almost 20% of new enrollees to AARP Medicare Supplement plans,” the authors wrote in the article. “These individuals were characterized by having high rates of self-reported memory loss, being older, having more chronic conditions, taking more medications and having high rates of past hospitalizations. All of these characteristics are associated with aging, thus as the Medicare population ages, we can expect a higher prevalence of homebound older adults.”
The article further stated screening of homebound older adults is needed, along with coordinated efforts with home healthcare agencies to better serve the patients’ physical and mental health needs.
According to the July 2015 JAMA article, “Epidemiology of the Homebound Population in the United States” by Katherine A. Ornstein, PhD, MPH, et al., researchers found the prevalence of homebound individuals in 2011 was 5.6%, which included an estimated 395,422 people who were completely homebound and 1,578,984 people who were mostly homebound.
“Only 11.9% of completely homebound individuals reported receiving primary care services at home,” the researchers wrote.
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For information on home care nursing, take the CE module “Becoming a Home Health Nurse.”