Home-Based Medical Care Is Concentrated Away From Most Homebound Patients
There is a "mismatch" between the needs of frail, elderly and homebound people in need of home visits by physicians, and the ability of the medical system to provide the healthcare professionals to meet that need, according to a report by the Department of Public Health Sciences at the University of Virginia School of Medicine, in Charlottesville. The study, which analyzed Medicare Provider Utilization and Payment Data for 2012 and 2013, found that only 5,000 primary care providers were responsible for home visits in 2013, while 53% of the patients who required treatment lived more than 30 miles from "high-volume providers." The report calls for distribution of home-based medical care to help reduce costs and hospitalizations.

About 4 million patients need home-based medical care because they are frail, functionally limited, and home bound. Simply put, they are not healthy enough to step out of their houses for medical attention. New research finds out just how much are the home-based medical care providers geographically concentrated or spread out.

It was found that roughly only 5000 primary care providers are responsible for a major chunk of home visits to Medicare fee-for-service beneficiaries in 2013. Most importantly, most homebound people live more than 30 miles away from these high-volume providers.

Nengliang Yao, PhD, an assistant professor in the Department of Public Health Sciences at the University of Virginia School of Medicine, in Charlottesville, led the study with fellow researchers. The findings are published in Health Affairs.

Home-Based Medical Visits

Using Medicare Provider Utilization and Payment Data for 2012 and 2013, the study measured home-based medical visits. The total home visits, average number of home visits, total Medicare payments, and average payments were calculated.

Primary care providers, such as physicians in internal medicine, family practice, geriatric medicine, nurse practitioners, and physician assistants, were identified as “high-volume providers.” These accounted for two-thirds of the providers of home-based medical care. In 2012 and 2013, they provided roughly 1.7 million (70%) of total home-based medical visits.

The distribution of these primary care providers was even more worrying. The study found that more than 53% of homebound patients lived in areas that were at least 30 miles away from the nearest high-volume medical provider.

Other noteworthy observations were as follows:

Home-based medical care has improved in general (meaning providers who make up to 1000 visits a year). However, Alaska, Hawaii, Maine, Mississippi, New Hampshire, Vermont, and many Midwestern states still do not have any healthcare professionals who make more than 500 visits a year.

During both the years, for professionals making more than 1000 visits a year, besides home visits, the top services were skilled home health care supervision, recertification of skilled home health services, and certification of skilled home health services.

During both the years, for professionals making between 500 to 1000 visits a year, besides home visits, the top services were more office-based care, domiciliary care, and nursing facility care.

Need for Better Distribution

“These data suggest a strong mismatch between the medical needs of homebound older adults and the ability of the medical system to provide care for them where they need to be served,” the authors wrote.

The nation’s demand for home-based medical care will only grow with the aging population. And currently, a large portion of vulnerable Americans are not being catered to well, resulting in large expenditures because of hospitalizations and visits to the emergency department. By better distribution of home-based medical care, the healthcare system can drastically bring down costs and provide better care.

“Home-based medical care has the potential to address healthcare challenges that result from an aging population with an increasing burden of complex chronic diseases,” the authors wrote. “However, the shortage and maldistribution of the workforce for home-based medical care constitute a continuing challenge to realizing the potential of that care.”