Home-Based Primary Care Did Not Reduce Medicare Expenditures

Home-based primary care seemed like it might bring back the old-fashioned house call and perhaps reduce the need for expensive medical care in the process by catching healthcare problems early.

Results from sixth year of the CMS’ Independence-at-Home demonstration project, which gave practices an incentive payment for providing home-based primary care may dim, if not extinguish, hopes that delivering primary care at home major will yield major cost savings. The estimated effect of Medicare expenditures was $41 per beneficiary per month (PBPM) in the Year 6 of the program, and that difference didn’t meet the standard tests for statistical reliability. CMS also reported that program did not reduce hospital admissions or emergency department visits.

The $41 PBPM in savings was much lower than the $330 PBPMB in savings I Year 5 and the $282 PBPM in Year 4. CMS said the decrease from Year 5 was caused mainly by one practice quitting the demonstration project. The project started with 18 participants but only 12 participated in Year 6.

CMS also reported that six of the nine practices that were eligible for incentive payments only met half of the quality measures, so those six practices received only 50% of the possible payment.

One of the key takeaways in the CMS’ “findings at the glance” about the results said this: “Results of the evaluation of the demonstration’s first six years provide no compelling evidence that the payment incentive affected the delivery of care in a way that measurably reduced Medicare expenditures or hospital use.”

In a sub-analysis, CMS found that at-home care lowered Medicare expenditures during the last three months of life, mainly because of lower inpatient expenditures of $624 PBPM.

CMS released the Year 6 findings on Nov. 22.