When it comes to reining in medical costs, delivering more health care and bringing it right to the patient's home can, for a select group of patients, save money.

These particular patients are elders struggling with multiple chronic medical conditions, such as congestive heart failure, stroke, diabetes or dementia. They make up just 5 percent of the people on Medicare, but they account for about half of all Medicare spending.

In a conducted by MedStar Washington Hospital Center in Washington, D.C., 722 such patients were provided with home-based health care delivered by a team: a physician, a nurse practitioner, licensed practical nurses and social workers. The visits were frequent, and there was someone on call for urgent situations 24/7.

"We prevent crises," says Dr. K. Eric De Jonge, the chief of geriatrics at MedStar Washington Hospital Center, and the lead author of the study. He says that having a doctor who has access to the patient's electronic medical records on call at all times cuts down on "having to call 911 and going to the emergency room, which often ends up in a hospital admission."

In fact, the study found that patients who received this home-based care had 20 percent fewer ER visits, 9 percent fewer hospitalizations and 27 percent fewer stays in a nursing home than similar Medicare patients in the control group. The death rate among these very vulnerable patients was high, but was about the same for both the study group and the control group.

The bottom line: In a two-year period, Medicare saved $8,477 for each patient getting home-based care.
MedStar Washington Hospital Center is one of 18 facilities nationwide participating in a Medicare demonstration project to gauge the impact of home health care on very frail patients. De Jonge says for such a system to work on a larger scale, Medicare would have to change the way it pays health care providers.

"You have to start paying people for their results," says De Jonge, "as opposed to the volume of how many things you do to the patient. Then this program could really take off."