Effects of Home-Based Primary Care on Medicare Costs in High-Risk Elders

Source: K. Eric De Jonge, Namirah Jamshed, Daniel Gilden, Joanna Kubisiak, Stephanie R. Bruce and George Taler, Journal of the American Geriatrics Society, Early View, July 18, 2014
(subscription required)

From the abstract:
Objectives
To determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders. …

Participants
HBPC cases and controls matched for sex, age bands, race, Medicare buy-in status (whether Medicaid covers Part B premiums), long-term nursing home status, cognitive impairment, and frailty. Cases were eligible if enrolled in MedStar Washington Hospital Center’s HBPC program during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland, and Pennsylvania. ….

Results
Mean age was 83.7 for cases and 82.0 for controls. 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, hospital, and skilled nursing facility care costs, and higher home health and hospice costs. Cases had 23% fewer subspecialist visits and 105% more generalist visits. In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary over 2 years of follow-up. There was no difference between cases and controls in mortality or in average time to death.

Conclusion
HBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls. ….