JAMDA 15 (2014) 538e540
JAMDA journal homepage: www.jamda.com
Editorial
Home Care, Need for Increased Physician Involvement in the 21st Century Gerald M. Mahon MD * Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
In the 21st century, the challenge for US health care will be to find ways to better care for the ever-growing homebound population. As of 2005, there were 2 million permanently homebound individuals, half of whom were age 65 or older. The homebound elderly population will increase to 3 million in the next decade. Millions more will be homebound temporarily, recovering from acute illnesses.1,2 By 2030, individuals aged 65 or older will be 20% of the US population. Many of these individuals will have multiple medical and psychiatric conditions, with resultant limitations in ambulation and transfers.3,4 In addition, the elderly are showing an increasing preference for being cared for in their homes.5 The cost of nursing home care continues to increase.6 As a result, there has been a decline in the number of nursing home beds per capita.7 Thus, the demand for care of the homebound individuals, especially the elderly, will continue to increase significantly. Historically, the US health care system has not been able to meet the needs of the homebound elderly.8 Despite improvement of care by home health nurses, social service agencies, and in-home hospice programs, there remains an important gap in services; namely, the lack of access to primary care physicians.9,10 The lack of primary care has contributed to the increasing use of the emergency room, hospitalizations,11 and decreased caregiver well-being.12 Home care, especially with physician involvement, has demonstrated multiple benefits. Studies evaluating the benefit of home care have demonstrated reducing nursing home admissions, improving functional status, and reducing mortality.13e17 A systemic review showed reduced nursing home admissions when more than 9 follow-up visits were used, improved functional status when a multidimensional geriatric assessment program was performed, and reduced mortality in individuals 73 to 77 years of age.18 Chronic conditions, such as congestive heart failure, have been successfully managed at home with the use of home care. Patients with heart failure undergoing a home care intervention were less likely to be hospitalized, and when hospitalized, spent shorter times in the hospital.19e21 Home-based primary care programs have demonstrated reduced hospitalizations and emergency room visits, and reduced costs of caring for their patients.22e25
The author declares no conflicts of interest. * Address correspondence to Gerald M. Mahon, MD, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St. Louis, MO 63104. E-mail address: [email protected] (G.M. Mahon).
US health care spending, especially Medicare spending, has increased significantly over the years.26 Older adults with 5 or more chronic conditions account for two-thirds of Medicare expenditures, and many are among the homebound population. A large percentage of Medicare spending is due to caring for elderly individuals during the last year of their lives. The excessive cost of care of these individuals is because of recurrent hospitalizations for the same condition. But, prolonged hospital stays, especially in the intensive care unit, contribute as well.27 With the passage of the Affordable Care Act in 2010, there has been increasing push to hold physicians and hospitals accountable for the medical costs their patients accrue. In addition, physicians and hospitals will be rated on quality measures, such as chronic disease management, readmission rates, length of hospital stays, and hospital mortality.28,29 The Centers for Medicare and Medicaid Services (CMS), especially the Center for Innovation, is testing various models of physician and hospital reimbursement, including accountable care organizations. The panel of patients that CMS will assign affordable care organizations (ACOs) will unknowingly include homebound patients. Homebound patients that each ACO will serve could impair the ability of the ACO to reduce medical expenditures below the benchmark that CMS assigns to them and affect their ability to meet quality measures expected of them.30e32 CMS and private insurance companies are also encouraging physician groups to establish medical homes as a way to reward physicians financially for their ability to improve patient access to care, reduce utilization of care, and improve quality of care.33 Physicians who are a member of an ACO or who operate a medical home should perform home visits to their homebound patients to reduce costs and maintain the quality of care they give to their patients.34,35 Homebound patients face an increasing dilemma of worsening isolation from the medical care they deserve. Home health care has been the main source of care that homebound patients receive in the absence of physician home visits or office visits.36 Before 1997, patients could receive home care with or without prior hospitalization. Some received care lasting more than 6 months at a time.37 The cost of home care to Medicare grew exponentially from $3.9 billion in 1990 to $17.2 billion in 1997. Congress enacted the Balanced Budget Act in 1997 limiting home care services to postacute care.38 In 2000, home health care payments were changed to a prospective payment system. The reduction in home care funding has resulted in the closure of more than 1000 home agencies, resulting in some rural areas to not have access to any home health care.39 There has been a negative impact on home care patients as a result of fewer home care services. Increased emergency room use and possible increased
1525-8610/$ - see front matter Ó 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine. http://dx.doi.org/10.1016/j.jamda.2014.04.020
Editorial / JAMDA 15 (2014) 538e540
mortality was documented by one study.40 Patients enrolled in Medicare advantage, who have less home health care coverage from their insurance, have also experienced poorer outcomes.41 All patients, including the homebound elderly, will have a harder time finding a primary care physician in the future. Fewer graduating medical students over the years have chosen general internal medicine or family practice as a career. Inadequate reimbursement and long working hours are cited as main reasons for this decline in primary care training. The number of patients in need of a primary care physician will increase exponentially over time.42 This will only further exacerbate the isolation homebound patients will experience from receiving any health care. In 1998, Congress increased the funding for physician home visits. One study showed physician house calls doubled from 2000 to 2006; however, the percentage of physicians making house calls decreased by 7.2%. The number of physicians performing house calls and the number of house calls performed must increase significantly to meet future demand.43 Congress has enacted the independence at home study to determine if home-based primary care groups can successfully reduce health care costs and maintain quality of care to warrant the government increasing funding for physician home care. If successful, CMS may improve funding for physician home visits to attract more physicians to perform them.44 Most medical schools have not provided adequate home care training for medical students and residents.45 A survey of home care education in medical schools showed only 3 medical schools had large home care programs that provided teaching for their medical students, residents, and fellows. A larger number did provide some home care lectures for students and residents. Many medical schools offer 1 home visit for students.46 Subsequently, 10 US medical schools received funding from the John A. Hartford Foundation to develop curricula in home care.47 There are no Accreditation Council for Graduate Medical Education guidelines requiring home visits for internal medicine residency programs. Family medicine residents are required to perform 2 home visits. Geriatric medicine fellows are required to perform home visits, as well.48 Medical schools should expand their current home care programs. This will increase homebound patients’ access to a primary care physician and improve teaching to medical students, residents, and fellows. Home-based primary care programs, such as the one at Mount Sinai Hospital, have demonstrated improvement in the health of the patients they serve, reduced caregiver burden, and reduced health care costs through reduced hospitalizations and emergency room use. Homebased primary care programs are financially viable when the financial benefit to the medical school and hospital are taken into consideration. Medical schools should provide formal teaching of home care through lectures, as well as home visits. Internal medicine and family medicine residents should be encouraged to perform home visits as part of their outpatient longitudinal care experience. It has been demonstrated that residents who saw patients in their homes were more likely to perform home visits in their practices.49 During the 21st century, medical schools should take the lead by emphasizing physician home care as a viable career choice for future physicians to meet the need of current and future homebound patients.
References 1. AAHCP Public Policy Statement 2013. American Academy of Home Care Physicians (online). Available at: http://www.aahcm.org/?page¼Pub_Policy_ Statement&hhSearchTerms¼%22publicþandþpolicyþandþstatementþandþ 2013%22. Accessed March 31, 2014. 2. Qiu WQ, Dean M, Liu T, et al. Physical and mental health of the homebound elderly: An overlooked population. J Am Geriatr Soc 2010;58:2423e2428.
539
3. Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995;333:1184e1189. 4. Fried LP, Kronmal RA, Newman AB, et al, for the Cardiovascular Health Study Collaborative Research Group. Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. JAMA 1998;279:585e592. 5. Higginson IJ, Sen-Gupta GJA. Place of care in advanced cancer: A qualitative systematic literature review of patient preferences. J Pall Med 2000;3:287e300. 6. Centers for Medicare and Medicaid Services. National Health Care Expenditures Projection: 2005e2015. Available at: http://www.cms.gov/Research-StatisticsData-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/ downloads/proj2008.pdf. Pg 4. Accessed March 31, 2014. 7. National Center for Health Statistics. Health, United States, 2006 with Chartbook on trends in the Health of America. Available at: http://www.cdc.gov/ nchs/data/hus/hus06.pdf. Accessed March 31, 2014. 8. Vladeck BC, Miller NA. The Medicare home health initiative. Health Care Financ Rev 1994;16:7e10. 9. Health and Public Policy Committee. American College of Physicians. Home Health Care. Position paper. Ann Intern Med 1986;105:454e460. 10. Muramatsu N, Cornwell T. Needs for physician housecallsdviews from health and social service providers. Home Health Care Serv Q 2003;22:17e29. 11. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency departmentdThe DEED II Study. J Am Geriatr Soc 2004;52:1417e1423. 12. Kasuya RT, Polgar-Bailey P, Takeuchi R. Caregiver burden and burnout. A guide for primary care physicians. Postgrad Med 2000;108:119e123. 13. Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: Systematic review and meta-analysis. BMJ 2001;323:1e9. 14. Huss A, Stuck AE, Rubenstein LZ, et al. Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci 2008;63:298e307. 15. Stuck AE, Minder CE, Peter-Wuest I, et al. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med 2000;160:977e986. 16. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994;331:821e827. 17. Tinetti ME, Baker D, Gallo WT, et al. Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care. JAMA 2002;287: 2098e2105. 18. Stuck AE, Egger M, Hammer A, et al. Home visits to prevent nursing homes admission and functional decline in elderly people: Systematic review and meta-regression analysis. JAMA 2002;287:1022e1028. 19. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995;333:1190e1195. 20. Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med 1998;158:1067e1072. 21. Stewart S, Horowitz JD. Home-based intervention in congestive heart failure: Long-term implications on readmission and survival. Circulation 2002;105: 2861e2866. 22. Wajnberg A, Wang KH, Aniff M, Kunins HV. Hospitalizations and skilled nursing facility admissions before and after the implementation of a homebased primary care program. J Am Geriatr Soc 2010;58:1144e1147. 23. Beales JL, Edes T. Veteran’s Affairs home based primary care. Clin Geriatr Med 2009;25:149e154. 24. Smith KL, Ornstein K, Soriano T, et al. A multidisciplinary program for delivering primary care to the underserved urban homebound: Looking back, moving forward. J Am Geriatr Soc 2006;54:1283e1289. 25. Beck RA, Arizmendi A, Purnell C, et al. House calls for seniors: Building and sustaining a model of care for homebound seniors. J Am Geriatr Soc 2009;57: 1103e1109. 26. Peterson CL, Burton R. CRS Report for Congress. US Health Care Spending: Comparison With Other OECD Countries. Washington, DC: Congressional Research Service; 2007. 27. Bodenheimer T, Fernandez A. High and rising health care costs. Part 4: Can costs be controlled while preserving quality? Ann Intern Med 2005;143:26e31. 28. Dowd BE, Parashuram S, Swenson T, et al. Value-based purchasing for physician services. Minnesota Med; 2013:43e45. 29. Sprague L. Seeking value in Medicare: Performance measurement for clinical professionals. National Health Policy Forum. Issue Brief No. 852. Washington, DC: George Washington University; 2013. 30. AAFP summary of CMS-1345-F. Medicare Shared Savings Program: Accountable care organizations final rule. November 2, 2011. 31. Correia EW. Accountable care organizations: The proposed regulations and the prospects for success. Am J Manag Care 2011;17:560e568. 32. White S, Kallem C, Viola A, Bronnert J. An ACO Primer. Reviewing the proposed rule on accountable care organizations. J AHIMA 2011;82:48e50. 33. Rittenhouse DR, Shortell SM, Fisher ES. Primary care and accountable caredtwo essential elements of delivery-system reform. N Engl J Med 2009;361: 2301e2303.
540
Editorial / JAMDA 15 (2014) 538e540
34. Landers SH. The other medical home. JAMA 2009;301:97e99. 35. Landers SH, Suter P, Hennessey B. Bringing home the ‘medical home’ for older adults. Cleveland Clin J Med 2010;77:661e675. 36. Meyer GS, Gibbons RV. House calls to the elderlyda vanishing practice among physicians. N Engl J Med 1997;337:1815e1820. 37. Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. N Engl J Med 1996;335:324e329. 38. Chen Q, Kane RL, Finch MD. The cost effectiveness of post-acute care for elderly Medicare beneficiaries. Inquiry 2000/2001;37:359e375. 39. Levine SA, Boal J, Boling PA. Home care. JAMA 2003;290:1203e1207. 40. McCall N, Korb J, Petersons A, Moore S. Constraining Medicare home health reimbursement: What are the outcomes? Health Care Financ Rev 2002;24:57e76. 41. Shaughnessy PW, Schlenker RF, Hittle DF. Home health care outcomes under capitated and fee-for-service payment. Health Care Financ Rev 1994;16:187e222. 42. Colwill JM, Cultice JM, Kruse RL. Will generalist physician supply meet demands of an increasing and aging population? Health Aff (Millwood) 2008;27: w232ew241.
43. Peterson LE, Lander SH, Basemore A. Trends in physician house calls to Medicare beneficiaries. J Am Board Fam Med 2012;25:862e868. 44. DeCherrie LV, Soriano T, Hayashi J. Home-based primary care: A needed primary-care model for vulnerable populations. Mt Sinai J Med 2012;79: 425e432. 45. Boling PA, Retchin SM, Ellis J, Pancoast SA. Factors associated with the frequency of house calls by primary care physicians. J Gen Intern Med 1991;6: 335e340. 46. Stoltz CM, Smith LG, Boal JH. Home care training in internal medicine residencies: A national survey. Acad Med 2001;76:181e183. 47. Leff B, Burton JR. The future history of home care and physician house calls in the United States. J Gerontol A Biol Sci Med Sci 2001;56:M603eM608. 48. Hayashi J, DeCherrie L, Ratner E, Boling PA. Workforce development in geriatric home care. Clin Geriatr Med 2009;25:109e120. 49. Perez JC, Brickner PW, Ramis CM. Preparing physicians for careers in primary care internal medicine: 17 years of residency experience. Bull N Y Acad Med 1997;74:20e30.
JAMDA journal homepage: www.jamda.com
Editorial
Home Care, Need for Increased Physician Involvement in the 21st Century Gerald M. Mahon MD * Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
In the 21st century, the challenge for US health care will be to find ways to better care for the ever-growing homebound population. As of 2005, there were 2 million permanently homebound individuals, half of whom were age 65 or older. The homebound elderly population will increase to 3 million in the next decade. Millions more will be homebound temporarily, recovering from acute illnesses.1,2 By 2030, individuals aged 65 or older will be 20% of the US population. Many of these individuals will have multiple medical and psychiatric conditions, with resultant limitations in ambulation and transfers.3,4 In addition, the elderly are showing an increasing preference for being cared for in their homes.5 The cost of nursing home care continues to increase.6 As a result, there has been a decline in the number of nursing home beds per capita.7 Thus, the demand for care of the homebound individuals, especially the elderly, will continue to increase significantly. Historically, the US health care system has not been able to meet the needs of the homebound elderly.8 Despite improvement of care by home health nurses, social service agencies, and in-home hospice programs, there remains an important gap in services; namely, the lack of access to primary care physicians.9,10 The lack of primary care has contributed to the increasing use of the emergency room, hospitalizations,11 and decreased caregiver well-being.12 Home care, especially with physician involvement, has demonstrated multiple benefits. Studies evaluating the benefit of home care have demonstrated reducing nursing home admissions, improving functional status, and reducing mortality.13e17 A systemic review showed reduced nursing home admissions when more than 9 follow-up visits were used, improved functional status when a multidimensional geriatric assessment program was performed, and reduced mortality in individuals 73 to 77 years of age.18 Chronic conditions, such as congestive heart failure, have been successfully managed at home with the use of home care. Patients with heart failure undergoing a home care intervention were less likely to be hospitalized, and when hospitalized, spent shorter times in the hospital.19e21 Home-based primary care programs have demonstrated reduced hospitalizations and emergency room visits, and reduced costs of caring for their patients.22e25
The author declares no conflicts of interest. * Address correspondence to Gerald M. Mahon, MD, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St. Louis, MO 63104. E-mail address: [email protected] (G.M. Mahon).
US health care spending, especially Medicare spending, has increased significantly over the years.26 Older adults with 5 or more chronic conditions account for two-thirds of Medicare expenditures, and many are among the homebound population. A large percentage of Medicare spending is due to caring for elderly individuals during the last year of their lives. The excessive cost of care of these individuals is because of recurrent hospitalizations for the same condition. But, prolonged hospital stays, especially in the intensive care unit, contribute as well.27 With the passage of the Affordable Care Act in 2010, there has been increasing push to hold physicians and hospitals accountable for the medical costs their patients accrue. In addition, physicians and hospitals will be rated on quality measures, such as chronic disease management, readmission rates, length of hospital stays, and hospital mortality.28,29 The Centers for Medicare and Medicaid Services (CMS), especially the Center for Innovation, is testing various models of physician and hospital reimbursement, including accountable care organizations. The panel of patients that CMS will assign affordable care organizations (ACOs) will unknowingly include homebound patients. Homebound patients that each ACO will serve could impair the ability of the ACO to reduce medical expenditures below the benchmark that CMS assigns to them and affect their ability to meet quality measures expected of them.30e32 CMS and private insurance companies are also encouraging physician groups to establish medical homes as a way to reward physicians financially for their ability to improve patient access to care, reduce utilization of care, and improve quality of care.33 Physicians who are a member of an ACO or who operate a medical home should perform home visits to their homebound patients to reduce costs and maintain the quality of care they give to their patients.34,35 Homebound patients face an increasing dilemma of worsening isolation from the medical care they deserve. Home health care has been the main source of care that homebound patients receive in the absence of physician home visits or office visits.36 Before 1997, patients could receive home care with or without prior hospitalization. Some received care lasting more than 6 months at a time.37 The cost of home care to Medicare grew exponentially from $3.9 billion in 1990 to $17.2 billion in 1997. Congress enacted the Balanced Budget Act in 1997 limiting home care services to postacute care.38 In 2000, home health care payments were changed to a prospective payment system. The reduction in home care funding has resulted in the closure of more than 1000 home agencies, resulting in some rural areas to not have access to any home health care.39 There has been a negative impact on home care patients as a result of fewer home care services. Increased emergency room use and possible increased
1525-8610/$ - see front matter Ó 2014 AMDA e The Society for Post-Acute and Long-Term Care Medicine. http://dx.doi.org/10.1016/j.jamda.2014.04.020
Editorial / JAMDA 15 (2014) 538e540
mortality was documented by one study.40 Patients enrolled in Medicare advantage, who have less home health care coverage from their insurance, have also experienced poorer outcomes.41 All patients, including the homebound elderly, will have a harder time finding a primary care physician in the future. Fewer graduating medical students over the years have chosen general internal medicine or family practice as a career. Inadequate reimbursement and long working hours are cited as main reasons for this decline in primary care training. The number of patients in need of a primary care physician will increase exponentially over time.42 This will only further exacerbate the isolation homebound patients will experience from receiving any health care. In 1998, Congress increased the funding for physician home visits. One study showed physician house calls doubled from 2000 to 2006; however, the percentage of physicians making house calls decreased by 7.2%. The number of physicians performing house calls and the number of house calls performed must increase significantly to meet future demand.43 Congress has enacted the independence at home study to determine if home-based primary care groups can successfully reduce health care costs and maintain quality of care to warrant the government increasing funding for physician home care. If successful, CMS may improve funding for physician home visits to attract more physicians to perform them.44 Most medical schools have not provided adequate home care training for medical students and residents.45 A survey of home care education in medical schools showed only 3 medical schools had large home care programs that provided teaching for their medical students, residents, and fellows. A larger number did provide some home care lectures for students and residents. Many medical schools offer 1 home visit for students.46 Subsequently, 10 US medical schools received funding from the John A. Hartford Foundation to develop curricula in home care.47 There are no Accreditation Council for Graduate Medical Education guidelines requiring home visits for internal medicine residency programs. Family medicine residents are required to perform 2 home visits. Geriatric medicine fellows are required to perform home visits, as well.48 Medical schools should expand their current home care programs. This will increase homebound patients’ access to a primary care physician and improve teaching to medical students, residents, and fellows. Home-based primary care programs, such as the one at Mount Sinai Hospital, have demonstrated improvement in the health of the patients they serve, reduced caregiver burden, and reduced health care costs through reduced hospitalizations and emergency room use. Homebased primary care programs are financially viable when the financial benefit to the medical school and hospital are taken into consideration. Medical schools should provide formal teaching of home care through lectures, as well as home visits. Internal medicine and family medicine residents should be encouraged to perform home visits as part of their outpatient longitudinal care experience. It has been demonstrated that residents who saw patients in their homes were more likely to perform home visits in their practices.49 During the 21st century, medical schools should take the lead by emphasizing physician home care as a viable career choice for future physicians to meet the need of current and future homebound patients.
References 1. AAHCP Public Policy Statement 2013. American Academy of Home Care Physicians (online). Available at: http://www.aahcm.org/?page¼Pub_Policy_ Statement&hhSearchTerms¼%22publicþandþpolicyþandþstatementþandþ 2013%22. Accessed March 31, 2014. 2. Qiu WQ, Dean M, Liu T, et al. Physical and mental health of the homebound elderly: An overlooked population. J Am Geriatr Soc 2010;58:2423e2428.
539
3. Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995;333:1184e1189. 4. Fried LP, Kronmal RA, Newman AB, et al, for the Cardiovascular Health Study Collaborative Research Group. Risk factors for 5-year mortality in older adults: The Cardiovascular Health Study. JAMA 1998;279:585e592. 5. Higginson IJ, Sen-Gupta GJA. Place of care in advanced cancer: A qualitative systematic literature review of patient preferences. J Pall Med 2000;3:287e300. 6. Centers for Medicare and Medicaid Services. National Health Care Expenditures Projection: 2005e2015. Available at: http://www.cms.gov/Research-StatisticsData-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/ downloads/proj2008.pdf. Pg 4. Accessed March 31, 2014. 7. National Center for Health Statistics. Health, United States, 2006 with Chartbook on trends in the Health of America. Available at: http://www.cdc.gov/ nchs/data/hus/hus06.pdf. Accessed March 31, 2014. 8. Vladeck BC, Miller NA. The Medicare home health initiative. Health Care Financ Rev 1994;16:7e10. 9. Health and Public Policy Committee. American College of Physicians. Home Health Care. Position paper. Ann Intern Med 1986;105:454e460. 10. Muramatsu N, Cornwell T. Needs for physician housecallsdviews from health and social service providers. Home Health Care Serv Q 2003;22:17e29. 11. Caplan GA, Williams AJ, Daly B, Abraham K. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency departmentdThe DEED II Study. J Am Geriatr Soc 2004;52:1417e1423. 12. Kasuya RT, Polgar-Bailey P, Takeuchi R. Caregiver burden and burnout. A guide for primary care physicians. Postgrad Med 2000;108:119e123. 13. Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: Systematic review and meta-analysis. BMJ 2001;323:1e9. 14. Huss A, Stuck AE, Rubenstein LZ, et al. Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. J Gerontol A Biol Sci Med Sci 2008;63:298e307. 15. Stuck AE, Minder CE, Peter-Wuest I, et al. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med 2000;160:977e986. 16. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994;331:821e827. 17. Tinetti ME, Baker D, Gallo WT, et al. Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care. JAMA 2002;287: 2098e2105. 18. Stuck AE, Egger M, Hammer A, et al. Home visits to prevent nursing homes admission and functional decline in elderly people: Systematic review and meta-regression analysis. JAMA 2002;287:1022e1028. 19. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995;333:1190e1195. 20. Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med 1998;158:1067e1072. 21. Stewart S, Horowitz JD. Home-based intervention in congestive heart failure: Long-term implications on readmission and survival. Circulation 2002;105: 2861e2866. 22. Wajnberg A, Wang KH, Aniff M, Kunins HV. Hospitalizations and skilled nursing facility admissions before and after the implementation of a homebased primary care program. J Am Geriatr Soc 2010;58:1144e1147. 23. Beales JL, Edes T. Veteran’s Affairs home based primary care. Clin Geriatr Med 2009;25:149e154. 24. Smith KL, Ornstein K, Soriano T, et al. A multidisciplinary program for delivering primary care to the underserved urban homebound: Looking back, moving forward. J Am Geriatr Soc 2006;54:1283e1289. 25. Beck RA, Arizmendi A, Purnell C, et al. House calls for seniors: Building and sustaining a model of care for homebound seniors. J Am Geriatr Soc 2009;57: 1103e1109. 26. Peterson CL, Burton R. CRS Report for Congress. US Health Care Spending: Comparison With Other OECD Countries. Washington, DC: Congressional Research Service; 2007. 27. Bodenheimer T, Fernandez A. High and rising health care costs. Part 4: Can costs be controlled while preserving quality? Ann Intern Med 2005;143:26e31. 28. Dowd BE, Parashuram S, Swenson T, et al. Value-based purchasing for physician services. Minnesota Med; 2013:43e45. 29. Sprague L. Seeking value in Medicare: Performance measurement for clinical professionals. National Health Policy Forum. Issue Brief No. 852. Washington, DC: George Washington University; 2013. 30. AAFP summary of CMS-1345-F. Medicare Shared Savings Program: Accountable care organizations final rule. November 2, 2011. 31. Correia EW. Accountable care organizations: The proposed regulations and the prospects for success. Am J Manag Care 2011;17:560e568. 32. White S, Kallem C, Viola A, Bronnert J. An ACO Primer. Reviewing the proposed rule on accountable care organizations. J AHIMA 2011;82:48e50. 33. Rittenhouse DR, Shortell SM, Fisher ES. Primary care and accountable caredtwo essential elements of delivery-system reform. N Engl J Med 2009;361: 2301e2303.
540
Editorial / JAMDA 15 (2014) 538e540
34. Landers SH. The other medical home. JAMA 2009;301:97e99. 35. Landers SH, Suter P, Hennessey B. Bringing home the ‘medical home’ for older adults. Cleveland Clin J Med 2010;77:661e675. 36. Meyer GS, Gibbons RV. House calls to the elderlyda vanishing practice among physicians. N Engl J Med 1997;337:1815e1820. 37. Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. N Engl J Med 1996;335:324e329. 38. Chen Q, Kane RL, Finch MD. The cost effectiveness of post-acute care for elderly Medicare beneficiaries. Inquiry 2000/2001;37:359e375. 39. Levine SA, Boal J, Boling PA. Home care. JAMA 2003;290:1203e1207. 40. McCall N, Korb J, Petersons A, Moore S. Constraining Medicare home health reimbursement: What are the outcomes? Health Care Financ Rev 2002;24:57e76. 41. Shaughnessy PW, Schlenker RF, Hittle DF. Home health care outcomes under capitated and fee-for-service payment. Health Care Financ Rev 1994;16:187e222. 42. Colwill JM, Cultice JM, Kruse RL. Will generalist physician supply meet demands of an increasing and aging population? Health Aff (Millwood) 2008;27: w232ew241.
43. Peterson LE, Lander SH, Basemore A. Trends in physician house calls to Medicare beneficiaries. J Am Board Fam Med 2012;25:862e868. 44. DeCherrie LV, Soriano T, Hayashi J. Home-based primary care: A needed primary-care model for vulnerable populations. Mt Sinai J Med 2012;79: 425e432. 45. Boling PA, Retchin SM, Ellis J, Pancoast SA. Factors associated with the frequency of house calls by primary care physicians. J Gen Intern Med 1991;6: 335e340. 46. Stoltz CM, Smith LG, Boal JH. Home care training in internal medicine residencies: A national survey. Acad Med 2001;76:181e183. 47. Leff B, Burton JR. The future history of home care and physician house calls in the United States. J Gerontol A Biol Sci Med Sci 2001;56:M603eM608. 48. Hayashi J, DeCherrie L, Ratner E, Boling PA. Workforce development in geriatric home care. Clin Geriatr Med 2009;25:109e120. 49. Perez JC, Brickner PW, Ramis CM. Preparing physicians for careers in primary care internal medicine: 17 years of residency experience. Bull N Y Acad Med 1997;74:20e30.
