Proving the obvious

Monday, September 26, 2011

Just because something is obvious doesn't mean you don't have to prove it.

So let's state the obvious: Home-based care is often vastly more cost-effective for post-acute and long-term care compared to institutional care. There is plenty of evidence in medical and policy literature to back it up. So now let's prove it.

* A 2004 assessment of clinical literature on long-term oxygen therapy by the U.S. Agency for Healthcare Research and Quality found oxygen therapy reduces both mortality and hospital frequency and length of stay for patients with severe COPD. The average number of hospital admissions per patient year decreased from 2.1 to 1.6 and the average number of days hospitalized decreased from 23.7 to 13.4 after long-term oxygen therapy. ("Long-Term Oxygen Therapy for Severe COPD," by J. Lau et al., June 11, 2004, Tufts-New England Medical Center Evidence Based Practice Center.)

* Analysis of long-term oxygen therapy in the American Journal of Managed Care concluded, "Continuous oxygen therapy for chronic obstructive pulmonary disease is highly cost-effective." The article states, "Medicare coverage can be improved by prescribing long-term oxygen therapy to patients who will receive substantial benefit and by providing adequate support for services and maintenance." ("Cost-Effectiveness of Long-Term Oxygen Therapy for Chronic Obstructive Pulmonary Disease," by Y. Oba, February 2009, AJMC.)

* A three-year program in Arkansas identified 919 rural Medicaid beneficiaries with unmet long-term care needs who were at risk for entering nursing homes. Health workers helped to connect them with home- and community-based care. Result: Annual spending on HME for these beneficiaries doubled over the three-year study period, from $728 to $1,432. In the comparison group of similar Medicaid beneficiaries who were connected to home and community care, annual spending on HME decreased while annual nursing home costs skyrocketed by $7,800. Spending growth for those who received home-based care was 23.8% lower than the comparison group. ("Medicaid Savings Resulted When Community Health Workers Match Those with Needs to Home and Community Care," by Holly Felix, July 2011 Health Affairs.)

* A New England Journal of Medicine article warns, "Health care organizations that do not adapt to the home care imperative risk becoming irrelevant." The author, Steven H. Landers, M.D. of the Cleveland Clinic, cites oxygen as an example of advances in portable medical technology, and parenteral nutrition and infusion as examples of care that are cheaper than and as equally effective as institutional care. ("Why Health Care Is Going Home," NEJM, October 20, 2010.)

* Analysis in the American Journal of Managed Care, March 2008, documents the economic burden of the chronic disease diabetes mellitus and the cost savings from testing. One tool shown to improve glycemic control is self-monitoring of blood glucose (SMBG). Clinical guidelines recommend SMBG at least three times daily for patients with diabetes who use insulin. The report demonstrates cost-effectiveness for SBMG patients who test both one and three times daily. ("Self-Monitoring of Blood Glucose in Type 2 Diabetes," by S. Tunis and M. Minshall, AJMC, March 2008.)

This summary just scratches the surface. There are more examples across the whole spectrum of HME products and services.

Michael Reinemer is vice president for communications and policy at the American Association for Homecare. Reach him at