2009 Annual Summary Report: Jewish Senior Life Physician House Calls Program
On March 27, 2008, the Department of Health notified the Jewish Home of Rochester, of approval as a demonstration site for the Home Based Primary Care for the Elderly Demonstration Program as authorized by Chapter 633 of the Laws of 2006. The demonstration is authorized for a period from April 1, 2008 to January 1, 2011.
As part of this demonstration project, the Jewish Home of Rochester was required to submit an annual report on the number of patients served, the types of services provided, the cost of the services, the sources of payment, and the number of patients served who no longer remain in their homes.
The Jewish Senior Life House Calls Program is the largest existing medical house calls program in Monroe County. This program provides comprehensive primary medical care to underserved, frail, homebound older adults, and patients at the end of life. According to the annual report, the goal of this program is to maintain patients in their community homes, increase access to medical care, reduce emergency room visits and hospitalizations and support caregivers.
Established in May 2008, The Jewish Senior Life House Calls Program was the first house calls program in NYS authorized under PHL 2820 "Home based primary care for the elderly demonstration program." Legislation allowed for continuing care retirement communities to offer a house calls program. Specifically, this program is staffed with two physicians and one nurse practitioner who each spend a period of time with the patients on this program. The remainder of their time is devoted to the management of short and long-term rehabilitation and nursing home residents. A registered nurse serves as the gatekeeper for this process, devoting part of her day in triage/care coordination and the remainder of time dedicated to practice management.
Care and Service Delivery
To ensure quality care and service delivery, Jewish Senior Life House Calls works collaboratively with other agencies including Visiting Nurse Service, Lifetime Care, Eldersource, Jewish Family Service, and Adult Protective Services to meet the goals of the patients they serve. Services are funded, in part, by grants received ($1.4 million) from the NYS Office for the Aging and Office of Mental Health.
Since inception, the Jewish Senior Life House Calls Program has provided services to a total of 135 patients, with a current census of 83 utilizing a bio-psycho-social care model working in partnership with the agencies listed above. The psychiatry department at the University of Rochester and Jewish Family Service of Rochester also collaborate with this program assuring that the unique mental health needs of the participants are met.
Medical visits are structured based on medical necessity and vary in frequency from weekly to every 3 months. Both physicians and their extenders conduct the home visits, with a family member or caregiver usually actively participating in a portion of the visit. Case management and counseling comprise a significant portion of each visit, which lasts 40-90 minutes based on the complexity of the individual's needs. There are an additional 4 telephone encounters with the RN care coordinator between visits. All acute concerns are addressed within a 24 hour period, with a physician or physician extender on call 24/7. To increase efficiency within the system an electronic medical record system was implemented in June 2009.
Revenue and Expense
In-home visits are reimbursed through the traditional payors including Medicare, Medicaid, and local Medicare Advantage plans. The program asserts that the reimbursement for these house calls is insufficient (travel, extended visits, etc.) to cover total costs, leaving a per year deficit of $1000 per patient.
|2009 YTD Expenses (thru 7/31/09)||$133,917|
The table below summarizes the disposition of the patients served during this program from May 2008 through July 31, 2009.
|Patients served since 05/27/08||135|
|Total number of house calls||663|
|Emergency Dept Visits||54 (50% resulted in hospitalization)|
|Total Discharges (Disposition noted below)||52|
|Nursing home placements||5|
|Transfer out of program||2|
|Hospitalizations||35 from 23 patients (several with multiple rehospitalizations)|
|Dismissed from program||1|
The Jewish Senior Life House Calls Program provides a unique service to residents of Monroe County. Of the 135+ patients served since the program's inception, only 23 patients required hospitalization on at least one occasion. Data analyzed to date, demonstrates that the provision of in-home medical care does correlate with a reduction in unnecessary hospitalizations, and provides needed support to both the patient and their families who choose to remain at home. Further analysis over the remainder of this demonstration project (April 1, 2008 – January 1, 2011) is necessary to determine the long term impact on this type of service delivery.