- - Thursday, April 24, 2014

Medicare may have overpaid $2 billion for fake house calls, HHS investigator says” (Web, April 15) contains significant errors. Further, it incorrectly informs the public that medical house-call providers are the source of a problem, when they should be seen as a major part of the solution.

The “face-to-face” visit that is now required to support that determination does not have to take place in the person’s home and rarely does. Most face-to-face visits are performed by office-based physicians or by hospitalists in hospitals. It is true that some home-care medicine providers (house-call providers) do provide such visits. However, among approximately 208,807 practicing physicians who are in primary care specialties, only about 7,000 physicians regularly make house calls.

Assuming $150 per house call (the average Medicare payment, including complex and new-patient visits, as well as follow-up visits), it would take 13.3 million fraudulently billed house calls to equal $2 billion. In fact, Medicare only received and paid $5.2 million in bills in total for home visits in 2012, and most of those were provided appropriately and documented appropriately. House-call physicians could not possibly be a significant source of the problem described.

There is no question that the concept of face-to-face visits is important. If there is fraud, we agree that it must be addressed. However, we would not want to lose sight of the central need and the core issues by highlighting fraud. The key for the future is to grow and strengthen the medical-care management of home-limited patients and avoid unnecessary and costly hospitalizations, not focus on fraudulent activity.

There is general acceptance now that our health care delivery system is ill-equipped to care for the rapidly increasing number of Americans with multiple and advanced chronic diseases. Those Americans make up just 5 percent to 25 percent of the Medicare population, while accounting for 43 percent to 85 percent of Medicare costs.

They are also the fastest growing segment of the Medicare population. The only provision of Obamacare that had unanimous bipartisan support was the Independence at Home program (Section 3024).

This model has proved successful for decades in the VA’s Home-Based Primary Care program and in the Washington Hospital Center’s house-call program, as well as in hundreds of other health care systems across the country. This care-delivery model is being widely adopted by health plans and providers because it is the only program that reduces health care costs where they are highest, while improving the quality of life and preserving the independence of patients with chronic illnesses.


Executive director

American Academy of Home Care Medicine

Edgewood, Md.

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