In a recent webinar for the RISE Association, FOX Rehabilitation offered an inside look at its geriatric house calls model to provide outpatient therapy to vulnerable seniors in the comfort of their homes. As an alternative option to the traditional models of post-acute rehabilitation, the program improves patient satisfaction while reducing total cost of care.
For the webinar, hosted by the RISE Association in mid-January, RISE was joined by Dr. William Dieter, director of PT clinical services, FOX Rehabilitation, who discussed the gaps in care the Geriatric House Calls model fills, the downstream cost reductions discovered through the model, and the importance of home-based outpatient therapy in a COVID-19 environment.
A new approach within the post-acute continuum of care
When it comes to the traditional post-acute continuum of care, there are typically two options:
- Home health agency through Medicare Part A
- Outpatient rehabilitation through Medicare Part B
But a third option exists that can serve as a better match for a portion of geriatrics, explained Dieter. “There are options that exist that we don’t currently think about when it comes to intervening, getting ahead of, or taking care of that problem before it turns into this cycle of events that ends up in higher cost, less quality of life, less satisfaction,” he said.
Home-based outpatient models such as Geriatric House Calls have been uncommon due to the legislation and compliance factors needed to support a home-based model. From a legislative standpoint, the therapy services are payable under the Physician Fee Schedule when furnished by a provider to its outpatients in the patient’s home, as stated in the Medicare Benefit Policy Manual IOM 100-2, but the feature is frequently overlooked, said Dieter. The legislation allows FOX to provide physical, occupational, and speech therapies under Medicare Part B in patients’ homes, which may be their actual place of residence, senior living facility, or a day program.
Dieter said the model is a cost-effective alternative for Medicare Part B beneficiaries who need outpatient therapy provided by physical, occupational, and/or speech therapist, but do not require additional services included in the home health agency or outpatient rehabilitation models, such as a nurse or social worker.
The beneficiaries who take part in the geriatric house calls model are among the most vulnerable, noted Dieter. The typical patient is on average, 82 years old, has a chronic health condition such as congestive heart failure, diabetes, COPD, stroke, or Parkinson’s disease, and an average risk adjustment factor of 2.61, which most closely resembles those seen in home health compared to typical outpatient settings, he explained.
Drivers behind the cost savings
As health care costs continue to rise disproportionately in older adults, especially those with chronic conditions, and the impending “silver tsunami” expected to exacerbate these costs as baby boomers move into their senior years, FOX recognized the need for innovation.
“We believe that we’re treating a vulnerable set of adults that are otherwise undertreated or not treated at all. And we believe that what we do–dosing exercise, building their reserve, enhancing functional wellness– if you enhance those things and work on those things, there’s going to be downstream savings to that,” said Dieter. “We view it as an investment in the wellness of these people and as a downstream cost reduction measure but of a population health approach to try and manage an older population that the current models are not really supporting properly.”
To better understand and analyze the value in the model, FOX partnered with Optum Advisory Services, a third-party Centers for Medicare & Medicaid Services (CMS) qualified entity. Using 100 percent of CMS claims data for 800,000 people, including Part A, Part B, and hospice, they found the model reduced total cost of care by 9.42 percent compared to non-FOX patients, meaning if any patient receives care through the model, it saves on average about $2,000 per person, explained Dieter.
The drivers behind the total cost savings include:
- A reduction in 90-day admits per 1,000 lives (41 percent)
- Shorter SNF lengths of stay (38 percent)
- Lower costs in bundle eligible patients (34 percent)
Another bonus: Dieter said that beneficiaries are also satisfied with the model. Using a third-party to make patient satisfaction phone calls, FOX asked more than 31,000 beneficiaries if they would recommend the program to a family member or friend, and 98.5 percent said yes.
COVID-19 exacerbates need for home-based outpatient care
The COVID-19 pandemic has prevented many older adults from going to doctor appointments and receiving necessary tests or screenings. Additionally, the increased social isolation reduces quality of life in older adults and puts them at an increased risk of cognitive impact, noted Dieter. “We’re going to start to really see the repercussions of all the things that have been happening by trying to keep everybody safe,” he said. “The time for innovation is now. The time to get in front of this is now.”
The model can play a key role in home-based outpatient health care throughout the pandemic by providing care to high-risk older adults at home while reducing hospital admissions and downstream health care costs, said Dieter. That care includes, but is not limited to, vital sign monitoring for high-risk patients at home, body system screening, facilitation of telehealth visits with other health care providers, and plans of care focused on fall risk, home modification, and communication strategies.
RISE webinars are free to members of the RISE Asssociation. Our next webinar is in partnership with Apixio for the Quality & Revenue Community on health care data acquisition, 1:30 p.m. EST., Wednesday, Feb. 17. To learn more about the association and its communities, click here.