Medicare Program Cut for Scalability Despite Cost-Saving Efficacy

If it aint broke, don’t fix it. This is the homespun wisdom Ken Coburn is imparting to the Secretary of Health and Human Services after learning Medicare is cutting funds for his program, Health Quality Partners, seemingly, because they can. The program, based out of Doylesville, Pennsylvania, provides weekly nurse visits to Medicare patients who have at least one chronic disease and one hospitalization within the past year. It’s a program that was approved by Medicare and extended, with great success, but now due to confusing bureaucratic lingo, the program is slated to be discontinued in June.

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Patients with chronic illnesses including heart disease, diabetes, cancer and even AIDS require long term care management. There is often no cure for a chronic diagnosis, but with medication, lifestyle change and other interventions, people are living longer than they did at the turn of the century. While some programs utilize crowded nurse call centers in different states for care management, the Health Quality Partners model of getting nurses out in the field to visit patients was revolutionary and the results, undeniable.

According to Mathematica Policy Research, the independent evaluator hired by Medicare to judge programs, Health Quality Partners reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent.

With such impressive results, why is Medicare squashing funding for HQP? For starters, they list “scalability” as a contributing factor. The HQP program is currently limited to Doylestown. Medicare is concerned that scaling up this small program to work nationwide, would not deliver a big enough return.

A frustrated Coburn has told Washington Post, “People always ask if what we do is scalable. Well, define scalable. It’s less difficult than open-heart surgery, which is one of the most common surgeries in the country, and it’s more difficult than giving a vaccine.”

For elderly patients enrolled in the program who don’t have close family (geographically or relational) having a nurse visit their home is a God-send. Due to minimal time allotment for each patient, doctors often seem visibly rushed. Patients may leave without understanding a diagnosis or medication regimen because they feel guilty about asking too many questions.

Bill Allen, a 79-year-old man enrolled in the program, says of his nurse, Patty Graefe, “Because she’s here in our home, you can feel more free to ask her anything. It’s great.” HQP nurses are doing more than taking vital signs, they’re building personal relationships.

Coburn may be frustrated about Medicare cutting funds to the Health Quality Partners program but he’s undeterred saying, “I really think we’re just at base camp. There are so many contributors to health the system isn’t addressing right now. As proud as I am of what we’re doing, I think we’re just scratching the surface of this stuff.”

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