In the story about the 2005 Legislative session... |
| ...(“Taxes, Reform to Rule Scene,” Times Union, January 2, 2005), the overview of legislative action for health care indicated “State leaders have pledged to reduce the growing burden of Medicaid spending borne by local government, but there’s little agreement on how to save money.” I suggest that legislators take a closer look at the cost savings that occur when medical care is delivered to patients in their homes. As the co-founder of Homedical Associates, the only medical practice dedicated to providing health-care services to homebound people in Albany, Schenectady, Rensselaer, and Saratoga Counties, I offer the following for consideration.
Health services research has indicated that more than 1 in 20 people over age 65 are homebound. When these individuals are placed in nursing homes, by the end of the first year, more than 90 percent will have their care financed by Medicaid at a cost of over $80,000 per year per person. This cost is shared by the Federal, State and County governments. In New York State, the state/local share is 50 percent. The governor’s proposed $100 billion budget includes $44 Billion for Medicaid, an increase of $14 billion or 46 percent over the past five years. One way to decrease the Medicaid financial burden is to provide medical care to people at home for as long as possible. Over 80 percent of long-term care services are provided at home by families, friends, and neighbors at no cost to Medicaid. The majority of medical care in the home is reimbursed largely by Medicare, a federal program. Medicaid does incur some cost, but mush less than institutional care. The path to moving costs from State and local sources involves encouraging Medicare programs. The role of the physician in homecare is crucial to maintaining people at home and preventing institutionalization and the rapid escalation of Medicaid costs, which are financed primarily by local property taxes. Here are my recommendations. Two bills have been introduced over the past four years to encourage the involvement of physicians in home care. These bills provided for the health departments in each county to receive $100,000 per year to fund medical care in the homes of homebound citizens. The first, S1993, was introduced by Senator Hugh Farley in 2001. This bill was held up for two years in the Senate Health Committee and was later withdrawn. The second, A01767, introduced by Assemblyman Paul Tonko in 2002, has been stalled in the Assembly Health Committee since then. Senator Farley and Assemblyman Tonko deserve our Failure to act will impose increasing tax burdens on every citizen by increasing the number of people admitted to nursing homes. This public-policy failure will only be exacerbated as the population ages, including the huge number of Babyboomers. For example, in the United States today about 68,000 people are over age 100. In 40 years, this number will increase to over one million, most of whom will require institutional care if medical care in people’s homes continues to be under funded. Next, I challenge individuals, local businesses and civic organizations to support the elderly and disabled in their desires to remain at home through the Alliance for Homebound People, Inc. This is a non-profit organization established by Homedical Associates to support the delivery of medical care to homebound individuals. Homedical Associates currently provides medical care to about 500 homebound people in the four-county Capital District. We estimate that there are at least 8,000 more in our area. Examples of the kinds of patients we care for include: • An 85-year-old woman who suffered from unrelenting pain related to osteoporosis and possible bone metastasis from recently diagnosed breast cancer. Her Homedical Associates physician visits her to evaluate her and to prescribe medication that relieves her pain and allows her to sleep. • A 54-year-old man who had not walked in about ten years since losing his left lower leg in a work-related accident. His Homedical Associates physician obtained an artificial limb for this patient, monitors his use of the limb, and manages his diabetes and medication regimen. • A 44-year-old man with Muscular Dystrophy who lives at home with his parents and requires a ventilator to breathe. Prior to the involvement of Homedical Associates, he experienced frequent hospital admissions. At one point, he was being admitted every two to four weeks. Since Homedical Associates assumed his care; his last admission was in Spring 2004. This patient’s situation represents a remarkable savings for taxpayers, since admission to the Critical Care Unit costs a minimum of $2,000 a day. The cost of a day of care at home is about $500. The financial risk for ensuring the availability of medical care in the home is, clearly, a public responsibility. Yet, currently, this responsibility is borne primarily by the physician. For example, the Medicaid payment for a physician home visit is $8.00. Medicare pays about $120, but this reimbursement is still inadequate to cover the cost of providing this essential medical care. As a result, Homedical Associates is facing a financial crisis and will be forced to close its doors unless a solution can be found. The cost of ensuring the continuation of medical care in the home in the Capital District is equal to the cost of providing nursing home care to one person for a year in each of the four Capital District counties. I contend that this cost is one of the best bargains in healthcare today. The disappearance of Homedical Associates will mean our patients, such as the ones cited above, will have an increased risk of illness and institutionalization at a much greater cost than ensuring that these services continue. Health services research has demonstrated that ambulatory people over age 65 have contact with their primary care physician 11 times a year. By contrast, their homebound counterparts have contact with their primary care physician only one time every two years. In many ways, the medical care provided to homebound people resembles that provided in Third World countries. This discrepancy must be addressed if we are to provide high quality healthcare to the frailest members of our society. I still hope that Homedical Associates will provide a prototype for counties in New York State for dealing with this health care crisis that will only intensify over the next 30 years. I believe that in-home medical care is needed to avert disaster. Medical care in the home is one of several interventions that can improve community long-term care. Supporting Homedical Associates and Alliance for Homebound People provides a cost-effective means to deal with this crisis. Our Web site (www.homedicalassociates.com) provides further information about how local organizations, foundations, and private philanthropists can help by becoming “Medical Missionaries” in their own backyards. David N. Hornick, M.D., M.P.H. |