Wyden Calls for Medicare Legislation to Fund House Calls for Homebound

U.S. Sen. Ron Wyden wants Medicare to expand a program nationwide that pays primary care physicians to treat seniors in their homes, and he plans to re-introduce legislation early next year.

Oregon’s senior senator pointed to the success of Portland’s Housecall Providers, which saved 32 percent on the cost of treating homebound seniors compared to a control group in the Portland Metro area in its first year, and was 26 percent cheaper the second year, as part of a Medicare demonstration project.

“It provides better care and better health outcomes at a much lower cost,” said Terri Hobbs, executive director of the nonprofit Housecall Providers, echoing the “Triple Aim” mantra that’s become common parlance in Oregon but still novel elsewhere in this country. “We provide primary care in their home. We can do X-rays and Ultrasound,” she added, using portable equipment.

Wyden’s office said Housecall Providers was the most successful of the 15 demonstration sites across the United States, but the only provider west of Texas. “Medicare should coordinate the wide array of services that an older person gets at home.”

The pilot project for Medicare was written into the Affordable Care Act, and the demonstration was extended last year under legislation sponsored by Wyden.

Turning the program into a standard offering for Medicare, including Medicare Advantage plans, will require new legislation in 2017, Wyden said.

Wyden is up for re-election this fall against little-known Republican Mark Callahan, a Salem information technology consultant. Wyden’s the heavy favorite, and if the Democrats retake the Senate -- which is highly possible -- he will move back into the chairmanship of the Senate Finance Committee, which oversees Medicare.

But either way, he said the program has bipartisan support from the current chairman, Sen. Orrin Hatch, R-Utah. “This will be one of the first issues we decide,” he told The Lund Report.

Housecall Providers sends out medical doctors, osteopathic physicians, nurse practitioners and physician assistants to people’s homes -- going far beyond the traditional home health services provided by aides and nurses, while still focusing on primary care. Their service is the next step in the evolution of care for seniors away from institutional settings and back into their homes, like old country doctors with modern technology, making it easier for older Americans to live in their homes as long as they can.

Wyden said there will be stipulations to get approval for the program, including a hospital stay within the past year, the existing use of home health aides, and the presence of chronic medical conditions in need of coordination and management. The costliest chronic disease combinations include stroke or kidney disease with asthma, chronic obstructive pulmonary disease, mental depression and congestive heart failure.

A report from the Brookings Institution noted that while 37 percent of people on Medicare have four or more chronic conditions, they account for 74 percent of the spending. Getting these costs under control while improving care is the goal both of Oregon’s coordinated care system for Medicaid and the program espoused by Hatch and Wyden.

The potential legislation will likely include greater funding for the coordination of care for the patients with multiple chronic conditions as well as greater funding for in-home primary care for patients who qualify.

Correction: The original article mistakenly framed the cost savings for Housecall Providers compared to standard care for seniors. We regret the error.