Homebound patients may face difficulties receiving traditional primary care.
Each year, millions of elderly patients are unable to leave their homes or require help to leave. These patients may experience cardiovascular disease, disabling conditions, or emphysema. For patients with functional limitations, or for those who are homebound, traveling to a primary care physician may not be possible, according to a report published by the Commonwealth Fund.
Not obtaining primary care can result in poor health outcomes and mental illnesses, such as depression, resulting from loneliness. These patients may benefit from receiving care in their own homes.
“These are the people you don’t see in grocery stores and restaurants. Because they also don’t get to the doctor, they often end up in the emergency department and the hospital in crisis,” said Terri Hobbs, executive director of Housecall Providers.
Currently, less than 12% of homebound individuals receive in-home primary care, according to the study. This may result in an uptick of preventable health issues.
In the report, the authors discuss one patient who visited the emergency department (ED) more than 120 times and spent 210 days in the hospital over a period of 7 years. Within 2 years of receiving in-home care, the patient visited the ED twice and was hospitalized twice.
In-hospital care focuses on frequent visits from collaborative teams to manage chronic diseases. The care teams help find social support for both patients and caregivers, as well as providing urgent visits, according to the report. The integrated care team meets frequently to discuss patient progress and situations that may require increased monitoring.
As healthcare is largely moving towards a value-based model, the interest in in-home primary care has surged. There is growing evidence that the programs can avoid hospitalization, ED visits, and nursing home placements, which can result in significant savings.
The authors also reported that there is evidence suggesting in-home care can improve the quality of care received.
In-home providers said that the high efficacy of the programs is based on provider-patient trust. This trust can allow providers to encourage positive changes in behavior, such as reminding patients to remain adherent to treatment.
In-home care programs typically have hour long appointments that can vary from weekly to daily. Each provider can treat an average 9 patients per day, according to the study.
A key benefit of these programs is the mitigation of unnecessary hospitalizations, which can be a time of significant stress for elderly patients. Instead of visiting the emergency department, patients can receive urgent visits.
In cases where hospitalization is necessary, the in-home care teams can facilitate communication between inpatient and outpatient providers, according to the report. This ensures that the visit is less stressful for patients.
Importantly, the teams can also help identify non-medical factors that may diminish health, including food instability or unsafe housing. They can also connect patients with care for behavioral and mental health conditions that may affect outcomes.
Despite the potential benefits, in-home care faces the problem of limited funding. The Commonwealth Fund reported that fee-for-service reimbursement from Medicare only provides $10 to $30 per visit, which does not properly cover the provider’s time traveling to the appointments.
Additionally, the providers have said that Medicare reimbursement for chronic care management is not sufficient because it does not cover costs for care coordinators and behavioral healthcare providers, and does not allow for longer visits, according to the study.
Many programs have sought innovative agreements with Medicare to receive higher reimbursement for services, while others have pursued risk-based contracts; however, these contracts require a significant shift in framework and can be very complex.
The success of in-home care programs will require payment models that result in participation by medical practices and training that prepares providers to work in patients’ homes, the study concluded.