|IAH is a groundbreaking demonstration project sponsored by the Centers for Medicare & Medicaid Services (CMS). It is designed to test whether home-based, coordinated care provided by practices like Doctors Making Housecalls (DMHC), can reduce the need for repeat hospitalization, improve patient and caregiver satisfaction, and lead to better health for beneficiaries and lower costs to Medicare. The project began in June of 2012, and was originally authorized for three years; however, it was so successful, Congress extended it for an additional 2 years. With strong bipartisan support, Congress is now considering making IAH a permanent Medicare benefit. If it is not extended beyond the current fifth year, it will end June 1st, 2017.
DMHC is one of only 15 practices nationwide selected by CMS to participate in the IAH demonstration. It was an honor to be selected, and it is even more of an honor that DMHC is the most successful practice in the demonstration, at least for the 2 years in which data is available. Detailed results of the study are available on the IAH website.
Patients must meet multiple, rigorous criteria to qualify for inclusion in the study, which focuses on complex, elderly patients – the 5% of Medicare beneficiaries which account for 50% of Medicare expenditures. As you know, these are the same patients DMHC specializes in caring for. They are also your residents. Below are the qualifications for patients to participate in the Independence at Home (IAH) program:
- Enrolled in traditional Medicare;
- In-patient hospital stay within the last 12 months;
- Enrolled with Home Health, SNF or in-patient OT/PT services within the last 12 months;
- Needs human assistance with at least 2 activities of daily living; and
- 2 or more chronic conditions
IAH practices are assessed not only on their ability to lower costs, but also on their ability to maintain or improve quality of care. There are 6 quality metrics, a detailed description of which is available on the IAH website.
There is one metric which generates all the calls from DMHC to the communities. It highlights the importance of “coordination of care,” especially for complex, elderly patients who reside in assisted living communities. According to that metric, IAH practices must:
Follow-up with contact between the practice and the patient or caregiver within 48 hours of a hospital admission, hospital discharge, or emergency department visit
Because DMHC patients are not outfitted with GPS location devices, the only way our staff has of “tracking” our patients’ whereabouts is to call each facility every day. That allows us to determine if a patient went out to the ED or hospital, or came back to the facility from the ED or hospital.
DMHC spends a great deal of time and effort to call each facility every day. We are also painfully aware that it takes facility personnel time to respond to those calls. We wish there was a more efficient way, but there’s not. If a patient has gone out to the hospital or ED, or come back from there, DMHC must then schedule additional calls and visits, to effectively coordinate care and satisfy additional quality-of-care criteria.
IAH practices are severely penalized by CMS for failing to meet the quality criteria. DMHC was one of only three IAH practices to meet all six quality criteria in each of the years for which data is available. We believe this makes a big difference in the quality of care we provide to our patients, and the facilities in which they reside.
We also believe this is one reason DMHC is the nation’s “gold standard” of on-site care, which should help communities attract residents. High quality care keeps residents aging in place, with as much dignity and independence as possible, as long as possible. This results in reduced turnover and increased length of stay for DMHC patients, which in turn boosts occupancy in the facilities we serve!