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P OSTER
A BSTRACTS
net margin of $48,980), if it covered the housing payment now made
by the veteran.
Conclusion: Medical Foster Home is a cost-saving alternative to
nursing home care. When organized as a virtual “firm”, a MFH program
can generate savings for further non-institutional care investment,
improving the re-balancing of long term living dollars.
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Improving Care for Frail Elders: A Home-Visiting Provider
Program for Medicare Advantage Members.
J. M. McBride, 1 R. D. Laird, 2 L. C. Hanson. 1 1. Division of Geriatric
Medicine and Center for Aging and Health, University of North
Carolina at Chapel Hill, Chapel Hill, NC; 2. Health First Aging
Institute, Melbourne, FL.
Supported By: Health First Health Plan, Melbourne, Florida;
INSPIRIS, Inc., Brentwood, Tennessee;
Center for Aging and Health, University of North Carolina at
Chapel Hill
Background: A Medicare Advantage plan in Florida desired to
improve the hospital readmission rate of members with repeated hospitalizations
and multiple medical co-morbidities, many of whom had
barriers to access. The plan partnered with a physician house call
company in 2004 to implement a home visit program, and evaluated
its effect on hospitalization rates.
Program Description: Patients were eligible for the program if
they had > 1 hospitalization in the previous 12 months and multiple
chronic illnesses; participation was voluntary with no additional cost
to the patient. Home visits were provided by physicians and nurse
practitioners who were employed full-time by the program; participants
maintained relationships with their primary care physicians.
Home visits were provided as needed, but no less than monthly. A
provider was always on call, making home visits on nights and weekends
as necessary. Telephonic nurse case managers were an integral
component of the program, coordinating and facilitating care.
Results: The program served 997 patients during 2010. 59%
were female, the mean age was 80.4 years, and the mean number of
major chronic disease diagnoses (included in the Medicare Hierarchical
Condition Categories model) was 2.96 per patient. The hospitalization
rate in 2010 for program participants was 1,047 per thousand
person- years, compared to an expected hospitalization rate of 2,611
using actuarially adjusted baseline data. For the entire 23,000 member
plan, the 30-day hospital readmission rate in 2010 was 15.2%,
compared to a baseline readmission rate of 18.2%. The decrease in
the 30-day readmission rate for the plan closely corresponded to the
decrease in hospitalizations among the program participants.
Conclusions:Implementation of a physician and nurse practitioner
home visit program is associated with a reduced hospitalization rate for
high risk geriatric patients. Clarification of the role of the home-visiting
provider as a“house call specialist”co-managing the member collaboratively
with the primary care physician was important in gaining acceptance
from members as well as community physicians.Community physicians
now see the program as an important resource for their most
vulnerable patients, and regular referrals to the program continue.
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Patients Surviving 6 Months in Hospice Care: Who are they?
L. Rothenberg, 1,5 G. Cordts, 2 L. Simon, 3 J. Gryczynski, 4
D. Doberman. 3 1. Stony Brook School of Medicine, Port Jefferson,
NY; 2. Geriatric Medicine and Gerontology, Johns Hopkins Bayview
Center, Baltimore, MD; 3. Gilchrist Hospice Care, Hunt Valley, MD; 4.
Friends Research Institute, Baltimore, MD; 5. Medical Student
Training in Aging Research (MSTAR) Program, Johns Hopkins
School of Medicine, Baltimore, MD.
BACKGROUND: In 2011, CMS regulation required U.S. hospices
to conduct a “face-to-face” (F2F) assessment of ongoing hospice
eligibility for all patients entering their 3rd certification period.
Using a cohort of patients enrolled in hospice we sought to characterize
those requiring F2F assessment.
METHODS: Retrospective program records were obtained for
hospice patients enrolled 6 months prior to January 1, 2011 (N=375).
Patients who remained in hospice on January 1, 2011 and received a
F2F (n=140) were compared to patients who were no longer in hospice
(n=235) on demographics, terminal condition, presence of comorbidity,
length of stay, and hospice outcome using bivariate statistics.
Predictors of F2F assessment were examined using a multivariable logistic
regression model controlling for demographics, setting of care
prior to admission, comorbidity, and primary terminal diagnosis.
RESULTS: Patients with a F2F were older (p64 years of age and reside within 35 miles
of the Durham, NC VA. Comprehensive in-home needs assessments
are performed by the COACH RN and social worker, with subsequent
case review by the full COACH team (geriatrician, geriatric
psychiatrist, geriatric pharmacist, RN, geriatric social worker) and
recommendations are made to PCP. Individualized follow-up plans
are developed and monitored.
Data from the 92 p-cd enrolled during the first 12 months of the
program’s existence were analyzed. Rates of NHP were tracked and
compared with historical controls. Health delivery was evaluated using
percentage of caregivers receiving education on available resources,
identification of patients with behavioral disturbance, and number of
geriatric psychiatry referrals. Caregiver burden was measured at baseline
and over time with the Caregiver Strain Index (CSI). Quality of life
was evaluated by caregiver satisfaction survey. Costs, cost avoidance
and savings were estimated and compared with accepted averages for
similar community populations to determine cost-effectiveness.
RESULTS
Three COACH patients were placed in nursing homes as compared
with the estimated average annual risk of NHP for COACH
patients of 13%, or 6 patients (50% reduction). Average CSI score
was reduced by one point, from 7 to 6. 90% of caregivers reported
AGS 2012 ANNUAL MEETING
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