Too Many People Live Far From Home Health Care

Many older Americans who have chronic diseases have limited access to in-home medical care, not only because of their location but also because primary care providers are less likely to visit their patients at home, according to a new study.

In fact, seven times more primary care providers visited nursing homes than patients at home over the course of the two-year study, and more than half of Americans live over 30 miles from a high-volume home health agency, according to the findings. The study centers on Medicare fee-for-service provider data from 2012 and 2013 to map the service areas of home-based medical care providers and identify gaps in coverage, Pantagraph reports.

“It’s fascinating, because it gives probably the first picture of the geographic spread of the home-based medical care workforce in the United States,” said Dr. Eric De Jonge, director of geriatrics at Medstar Washington Hospital Center in Washington, D.C. and co-founder of MedStar’s Medical House Calls Program.

Approximately 5,000 primary care providers made 1.7 million home visits to Medicare fee-for-service patients each year of the study, according to the study’s lead author Nengliang Yao, an assistant professor in the department of public health sciences at the University of Virginia School of Medicine, and his team of researchers. Nearly 10% of those providers were responsible for almost half of the home care visits.

A disconnect in reimbursements for physicians making house calls versus nursing home visits appears to be an obstacle in getting more doctors and nurses on board for home-based health care, the study suggests. In 2012, for example, internal medicine physicians made about 500,000 trips to patients at home, as compared to 8 million skilled nursing visits. What’s more, Medicare paid those providers $500 million for nursing home visits, which is 10 times more than what is paid for home visits, according to the study.

Medicare reimbursement for physician house calls varies from state to state, the study’s authors reported. Medicare spent more than $10 per beneficiary on home-based medical care in some states, and spent less than 10 cents per beneficiary in others.

“We need to find a financial model to attract young doctors, nurse practitioners and physician assistants to come into this field,” Yao said.

The study’s results come as the Centers for Medicare & Medicaid Services (CMS) released the results of its Independence at Home demonstration, which saved Medicare more than $10 million this year. CMS is testing home-based care as part of an ongoing “shared savings” project, Pantagraph reported.

Written by Kourtney Liepelt