Homebound Seniors Remain Disproportionately Costly For Medicare

Homebound seniors contribute to higher overall Medicare spending compared to their non-homebound counterparts, according to a recent study from researchers at the Icahn School of Medicine at Mount Sinai.

The study examined National Health and Aging Trends data and Medicare fee-for-service claims data to give an overview of health care utilization and spending among homebound seniors.

“Understanding the health care needs and costs of homebound older adults is vital to health policy priority setting and shaping the future of long-term care,” the researchers wrote in the study.


Broadly, the study considers seniors that leave their homes once a week or less homebound. Roughly 1.5 million people make up this population.

“The homebound are disproportionately Hispanic and Black non-Hispanic, medically and socially complex, and isolated. And their numbers are rising,” Benjamin Oseroff, a third-year medical student at Icahn Mount Sinai who led the study, said in a press statement.

Though they’re only 5.7% of the Medicare fee-for-service population, homebound seniors aged 70 and older accounted for 11% of Medicare spending in 2015, according to the study.


Additionally, Medicare spending is $11,346 higher among homebound seniors.

“The homebound are even more concentrated among the top spenders, making up nearly 14% of those in the 95th percentile or above of Medicare spending,” Oseroff said. “In light of these findings, the homebound represent a critically important population to target for quality improvement and reductions in Medicare spending.”

Homebound patients heavily utilize hospital-based care. This is one of the reasons there’s a spike in costs among this population.

An estimated 40% of homebound seniors had a hospitalization annually. When looking at non-homebound seniors, roughly 20% have been hospitalized annually.

The researchers also noted that homebound seniors are not utilizing outpatient care. Only 61% of homebound seniors received an annual primary care visit. Among non-homebound seniors, 72% received an annual primary care visit.

“Despite being older and more medically complex, the homebound have lower rates of accessing outpatient care than the non-homebound,” the researchers wrote. “When adjusting for demographic, clinical and geographic differences, we find the homebound have only a small increase in the probability of having a home health visit compared to the non-homebound, suggesting that the gap in outpatient care is not being substituted for by home-based care within Medicare.”

Indeed, the barriers that block seniors for accessing home-based care under Medicare have been well-documented.

Some of the contributing factors include lack of awareness among Medicare beneficiaries, doctors not ordering care services and providers failing to deliver care.

Despite the popularity of telehealth in response to the COVID-19 emergency, the researchers push back on it being an end-all, be-all solution, citing a 2021 study that found barriers to virtual care. These roadblocks include lack of broadband access, no help for technology use, and cognitive and sensory impairments.

Researchers did, however, point to the policy and program efforts to increase access to home-based care.

“Over the past two decades, federal and state policy makers have increased investment to provide more long-term services and supports to older patients in the home and funded projects like the Center for Medicare & Medicaid Innovation’s Independence at Home demonstration to provide home-based primary care to the frailest Medicare beneficiaries,” the researchers wrote. “The American Rescue Plan Act of 2021 included $460 million in increased Medicaid funding for home and community-based services, and the Biden administration has proposed significant additional federal investment in these services.”

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