DASH Program Serves as National Model for Helping Homebound Patients

June 28, 2017

Island internist Dr. Jack Resnick has been a champion and advocate of in-home care for the past two decades. His quest began in 1998 after he lost a 48-year-old quadriplegic patient to a hospitalization gone wrong. According to Resnick, if the patient’s urinary tract infection had been treated at home, the antibiotic-resistant bedsore that caused his death would have been prevented. 


Dr. Jack Resnick started the DASH program


Convinced that in-home care extends both the longevity and the happiness of homebound chronic patients, Resnick started the Disabled Association Support for the Homebound, known as DASH. Resnick says in-home services allow for patients to avoid unnecessary hospitalization, especially in institutions that have no expertise in their respective diseases, and saves on costly procedures. 


It’s a vision that is gaining City-wide and national attention.


In 2011, as an appointed Innovation Center Fellow under the Centers for Medicare and Medicaid Services (CMS), Dr. Resnick submitted a comprehensive plan to roll out in-home care throughout New York City. The Independence at Home Demonstration, passed at the same time as the Affordable Care Act under section 3024, requires participating practices to provide in-home primary care to chronically ill Medicare patients. Originally set up as a three-year demonstration project, the program was then extended for another two years through September 30, 2017. 


And it’s already seen success. According to the second-year analysis and results for the program, which were released by the CMS last summer, not only did the program make treatment more personal, allowing healthcare providers to spend more time with their patients and provide more effective care, it saved an average of $746 per beneficiary. Half of the participating practices were able to reduce costs while increasing care, allowing them to win monetary incentives. 


In 2014, Resnick also testified in front of a congressional committee to support legislation that expands health innovation via telehealth (at-home direct video conferencing with physicians), and other technologies that can assist homebound patients with their care while not forcing them to leave the comfort of their homes. 


However, despite its positive results, Resnick says that, with a new federal administration which appears set specifically against universal healthcare, and more generally against the weak and poor in our society, it is hard to predict what will become of the Independence at Home program. 


“[The program] is currently up and running in 15 spots around the country, with high-quality results in terms of lowering mortality and [increasing] patient satisfaction,” says Resnick. “But, even if successful, it will require an act of Congress [to make the program permanent].” The bi-partisan legislation was introduced last summer, before the current administration came into office. 


Today, Resnick continues to fight for the program while still maintaining his own infrastructure for his patients on the Island and elsewhere. He says he’s trying to approach the issue from new angles. “Much of Medicare is not administered by the government anymore but by insurance companies; and they are interested. So I intend to repackage it and push it again through the insurance companies… It is my best bet.” 


Despite seeing insurance companies as more welcoming to the program, Resnick believes another way is to go through State governments, as opposed to the federal government. Dr. Resnick acknowledges that he has his work cut out for him. He explains that even doctors are resistant to change and are not open to sign on to any new patient-care ways. 


Despite the uncertainty surrounding healthcare these days, Resnick thinks it is logical for the Trump administration to extend the program and make it permanent. “[The program] requires no federal funds and, as the legislation was written originally, it was intended for doctors and doctor groups… In the end, it lowers costs for institutions that are actually losing money on these patients almost every time they walk in the door.” 


With convincing results for both patients and providers, Resnick hopes the program will not meet the resistance and obstacles of political interests and games, but rather the seriousness of legislators who are supposed to serve the public and their constituents. 


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