Health Care Reform Promoting House Call Medicine?

Independence At Home

While the health care reform debate continues to move through congress, it’s uncertain what changes may be in the bill’s future. However, many are hoping that one program, Independence at Home, remains a part of final product. Independence at Home is a program mandated by the health care reform law that supports expanding house call medicine, a core function of concierge medicine.

Independence at Home, a program that will officially launch on January 1 of 2012, focuses on preventative health care by “improving health outcomes and reducing preventable hospitalizations, readmissions and emergency department visits. Decreasing the number of duplicative diagnostic and laboratory tests and improving patient and caregiver satisfaction” will reduce overall expenses related to Medicare beneficiaries, according to American Medical News.

“This is designed for relatively small practice groups to participate,” said Peter Boling, MD, professor of medicine and interim chair of the division of internal medicine at Virginia Commonwealth University School of Medicine in Richmond, who advocated for the Independence at Home program to be part of health system reform. “We are very excited, and we really hope it will become a national program.”

The rate at which house call medicine is rising is moving faster than insurance companies can keep up with, which is why Independence at Home offers payment incentives for primary care teams providing house calls. Just in the last few years, Medicare has paid for more than 2.3 million house calls, compared to only 1.5 million house calls made in the early 90’s.

Health care providers around the nation are gearing up for Independence at Home to take effect on January 1st by incorporating house calls into their programs. Accountable Care Organizations, a new model for delivering health services that offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping costs down, will be at the forefront of this operation.


Accountable Care Organizations are a new addition to the health care field; a concept brought forth in the health care reform bill. The full details of who will run ACO’s and exactly what they’ll be in charge of are still a little foggy, but the overall impression is that their purpose will be to provide financial incentives to hospitals and physicians who provide preventative care that reduces overall costs.

According to NPR, an ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. Under the new law, ACOs would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

In effect, ACO’s will promote coorporation between medical providers who will be encouraged to work seamlessly together in order to avoid unnecessary tests and procedures that ultimately raise costs for everyone.  Besides providing incentives to health care providers, ACO’s themselves will be under pressure to meet high standards or risk losing their contracts.

In Medicare’s traditional fee-for-service payment system, doctors and hospitals generally are paid more when they give patients more tests and do more procedures. That drives up costs, experts say. ACOs wouldn’t do away with fee for service but would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers would get paid more for keeping their patients healthy and out of the hospital, according to NPR.

Preventative Care

Preventative care is not only one of the core values of concierge medicine, it is a factor that many say will “bend the cost curve” and pull our health care system out of its fiscal nose dive. The preventative medicine debate is an interesting one, much like the health care reform debate, and while the surface idea is to prevent disease and save lives, the secret just below the surface is that preventative medicine could mean saving a lot of money.


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