ABSTRACT
Objectives
Home-based medical care (HBMC) delivers physician or advanced practice provider–led
medical services for patients in private residences and domiciliary settings (eg,
assisted living facilities, group/boarding homes). We aimed to examine the time trends
in HBMC utilization by care settings.
Design
Analyses of HBMC utilization at the national and state levels during the years 2012–2019.
Setting and Participants
With Medicare public use files, we calculated the state-level utilization rate of
HBMC among fee-for-service (FFS) Medicare beneficiaries, measured by visits per 1000
FFS enrollees, in private residences and domiciliary settings, both separately and
combined.
Methods
We assessed the trend of HBMC utilization over time via linear mixed models with random
intercept for state, adjusting for the following state-level markers of HBMC supply
and demand: number of HBMC providers, state ranking of total assisted living and residential
care capacity, and the proportion of FFS beneficiaries with dementia, dual eligibility
for Medicaid, receiving home health services, and Medicare Advantage.
Results
Total HBMC visits in the United States increased from 3,911,778 in 2012 to 5,524,939
in 2019. The median (interquartile range) state-level HBMC utilization rate per 1000
FFS population was 67.6 (34.1–151.3) visits overall, 17.3 (7.9–41.9) visits in private
residences, and 47.7 (23.1–86.6) visits in domiciliary settings. The annual percentage
increase of utilization rates was significant for all care settings in crude models
(3%–8%), and remained significant for overall visits and visits in domiciliary settings
(2%–4%), but not in private residences.
Conclusions and Implications
The national-level growth in HBMC from 2012–2019 was largely driven by a growth of
HBMC occurring in domiciliary settings. To meet the needs of a growing aging population,
future studies should focus efforts on policy and payment issues to address inequities
in access to HBMC services for homebound older adults, and examine drivers of HBMC
growth at regional and local levels.
Keywords
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Article info
Footnotes
The study was supported by the National Institute on Aging (P01 AG066605 and P30AG028741). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
The authors declare no conflicts of interest.
Author Contributions: B. Liu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: K.A. Ornstein, C. S. Ritchie, B. Liu. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: B. Liu. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: B. Liu. Supervision: K.A. Ornstein, C. S. Ritchie.
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