- The majority (80%) of accountable care organizations report using home visits for some patients with complex needs, according to new research published in Health Affairs. Larger, integrated ACOs were more likely to use home visits due to the high staffing costs associated with implementing a home visits program.
- All ACOs reported using non-physician staff to conduct home visits, and most frequently for care transitions home visits once patients are discharged from the hospital. Medicaid ACOs were most likely to use care transitions home visits (86.7%) compared with 82% of Medicare ACOs and 79.6% of commercial ACOs.
- While ACOs report successfully using home visits to identify unmet social and clinical needs of complex patients, researchers found challenges addressing those needs persist. High implementation costs and reimbursement rules are also roadblocks to improving care.
The house call continues to make its triumphant comeback, leaping from the pages of medical antiquity directly into the epicenter of modern innovation. Analysts estimate the global smart home healthcare market will reach $30 billion by 2023, physicians are adopting telehealth technologies at a rapid clip and home health workers are in high demand.
High costs of hospital utilization, coupled with the Medicare-eligible population's preference for aging in-place, are two driving forces behind the return of home visits.
Researchers from the Dartmouth Institute for Health Policy and Clinical Practice and the University of Oxford, however, say current CMS policies are holding the home visit back, especially for ACOs, which in many ways are regarded as a model of value-based care.
CMS does allow physicians to bill for patients who are unable to receive care in an office setting in its traditional fee-for-service model. However, according to the study's authors, most home visits described to them by ACOs would not qualify for reimbursement. The researchers encouraged policymakers to "continue to align reimbursement with evidence-based care innovations such as home visits."
The Center for Medicare and Medicaid Innovation (CMMI) recently announced results for its home-based primary care demonstration, an incentive-based payment model aimed at improving care for chronically ill patients. The demonstration ended its fourth year reducing Medicare expenses by $282 per beneficiary per month.
At the end of last year, CMS finalized Pathways to Success, a set of Medicare Shared Savings Program regulations forcing more risk on ACOs at a faster rate. New beneficiary incentives and telehealth services included in the rule were not enough to keep many smaller physician-led ACOs on-board.
Hospital-led ACOs, which are better-resourced and able to withstand more downside risk, have largely remained in the program. That's in-line with the recent findings from Dartmouth and Oxford researchers, which demonstrates a higher tolerance among larger, integrated ACOs for costs associated with home visit programs.
Smaller practices, they write, may require "further financial or logistical support" to make home visits viable.