Page 23 - Layout 1

GERIATRIC
illness. A paradigm shift is needed to care for this aging popula-
tion or the costs will continue to increase as our society ages. The
sickest patients (10 percent of the Medicare population), those
with five or more chronic conditions, drives more than half of
Medicare costs. These patients are also the target population of
home visiting practices (Cornwell, 2015).
Prevention of ER visits and hospitalization is the goal of home
visit medical groups and it seems to be working. The cost of one ER
visit is equivalent to around 10 home visits.
Data published in the New England Journal of Medicine in April
2009 revealed that 20 percent of Medicare hospital discharges were
readmitted within 30 days and 34 percent within 90 days. Half of
the 30-day readmitted patients had not seen a physician since their
hospital discharge. Attempts to reduce readmissions with Medicare
home health (nurses, therapists, social workers, aides) were generally both young and old to consider entering this emergent practice.
not successful, with readmission remaining high around 28 percent.
In contrast, home care medicine by doctors, nurse practitioners and
physician assistants has shown to have a profound effect on both re-
duced readmission and healthcare costs.
A study by Naylor, published in the Journal of the American
CARE
Geriatric Society in 2004, showed that house calls for three
months post-hospitalization cut readmission by more than half
(23 in the house call group versus 63 in the control group). Figure
2 below shows the tremendous cost savings. The home visit inter-
vention stopped at three months but benefits continued for an ad-
ditional three months, with over 50 percent reduction in
readmission in cost versus the control population. No further ben-
efits were seen in the 6-12 month period, showing the need for
continued long term home visits.
Restoring the doctor-patient relationship is of paramount impor-
tance. The potential of home medicine has barely been tapped.
With all the technological advances, home visits offer effective treat-
ment and improve the quality of life of the aging population while
decreasing the number of ER visits, hospitalizations and readmis-
sions after discharge. This field is wide open and I encourage doctors
David Cavazos, Practice Manager – Doctor At Your
Service (DAYS), Phone: 210-771-5622, dcavazos@doctor-
atyourservice.com.
visit us at www.bcms.org 23