According to a report released in 2012 by the Medicare Payment Advisory Commission (MedPAC), almost 60 percent of emergency room visits and 25 percent of hospital admissions of Medicare patients were potentially preventable.
As part of Atrius Health’s efforts to reduce healthcare costs and provide high quality ambulatory care for our Medicare population, programs have been implemented to help reduce unnecessary hospitalization and emergency room (ER) visits by patients.
One of these programs being piloted by Granite Medical Group is the Intensive Home Based (IHB) program. Dr. Daniel Oates, who is board certified in internal medicine and geriatrics, manages the IHB program and oversees the skilled nursing facility and home-based care team and is the primary care provider for some of Granite Medical’s home-bound patients.
Granite Medical started this program in April of 2013 and the focus is on frail elders who live at home or in an assisted living facility. The patients who are part of this program have been identified as “high risk” and tend to have very complex medical issues and may or may not have support from their family to come into the office. These patients may have contacted 911 or gone to an emergency room in the past when that visit could have been avoided if their medical condition didn’t escalate.
Patients are referred to this program in various ways:
A nurse discusses the home visit program with the patient and their family and an initial in home evaluation with Dr. Oates is set up. In home visits are scheduled based on the acuity of the medical condition of the patient.
The goal is for the doctor to access the patient’s medical condition and anticipate medical issues before they escalate to a point where emergency care is needed. He works with patients on things such as medication review and quality of life and then comes up with a plan to keep these patients out of the hospital and ER.
An example of how this program has worked is a patient who is transfusion dependent. Her symptoms would reach an acute level and she would call an ambulance and need to be hospitalized. The patient was unable to get into the office for appointments, so her symptoms were not being managed properly. Now that Dr. Oates visits this patient at home, he can monitor her levels and anticipate when a transfusion is necessary. Dr. Oates and his staff can then schedule an appointment for a transfusion and arrange for transportation to and from the hospital. This not only saves thousands of dollars in medical costs, but it also benefits the patient by keeping her medical condition under control.
By avoiding just one hospitalization a month, the IHB program will pay for itself. This program not only makes a positive impact on reducing healthcare costs, it also benefits patients by anticipating and managing chronic symptoms and avoiding unnecessary time waiting in an ER.