The positive financial contribution of home-based primary care programs: the case of the Mount Sinai Visiting Doctors.

The coming decade will see a rise in the number of homebound seniors. These vulnerable patients have great difficulty accessing primary care. Home-based primary care (HBPC) can fill this healthcare need. Presently, such programs have been slow to develop, in part because of the perception that they are fiscal liabilities. Using the Mount Sinai Visiting Doctors (MSVD) program, the total financial effect of an HBPC program on an Academic Health Center (AHC) was assessed. A retrospective cohort analysis (n=692, 565 patient years) of Medicare-eligible individuals who were enrolled in the MSVD HBPC program was conducted. Revenues and associated costs for direct physician home care services, inpatient admissions, and outpatient clinic and emergency department visits for 1 calendar year were captured. Sensitivity analyses varying efficiency and cost variables were performed. Total direct cost for HBPC for the patient cohort was $976,350. Direct billing from home visits generated revenues that covered 24% of total direct care costs. Over a 12-month period, the cohort had 398 inpatient admissions and 1,100 non-HBPC outpatient visits, generating an overall contribution to margin of nearly $2.6 million. It is likely that this analysis underestimates the true contribution to margin, because it does not capture patient encounters at specialty clinics not in the Department of Medicine, unaffiliated medical centers, or private community-based practices. Although direct billing for HBPC programs does not generate enough revenue to meet operating costs, they can be significant revenue generators for the wider healthcare system and thus are fiscally worthy of subsidization.