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Growth of Fee-for-Service Medicare Home-Based Medical Care Within Private Residences and Domiciliary Care Settings in the U.S., 2012–2019

      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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      References

        • Caffrey C.
        • Sengupta M.
        • Melekin A.
        Residential care community resident characteristics: United States, 2018.
        NCHS Data Brief. 2021; : 1-8
        • Caffrey C.
        • Harris-Kojetin L.
        • Rome V.
        • Sengupta M.
        Characteristics of residents living in residential care communities, by community bed size: United States, 2012.
        NCHS Data Brief. 2014; 171: 1-8
        • Kaiser Family Foundation
        Total Number of Residents in Certified Nursing Facilities.
        • Yao N.
        • Ritchie C.
        • Cornwell T.
        • Leff B.
        Use of home-based medical care and disparities.
        J Am Geriatr Soc. 2018; 66: 1716-1720
        • Reckrey J.M.
        • Yang M.
        • Kinosian B.
        • et al.
        Receipt of home-based medical care among older beneficiaries enrolled in fee-for-service Medicare.
        Health Aff (Millwood). 2020; 39: 1289-1296
        • Leff B.
        • Carlson C.M.
        • Saliba D.
        • Ritchie C.
        The invisible homebound: setting quality-of-care standards for home-based primary and palliative care.
        Health Aff (Millwood). 2015; 34: 21-29
        • Zimbroff R.M.
        • Ornstein K.A.
        • Sheehan O.C.
        Home-based primary care: a systematic review of the literature, 2010–2020.
        J Am Geriatr Soc. 2021; 69: 2963-2972
        • Stall N.
        • Nowaczynski M.
        • Sinha S.K.
        Systematic review of outcomes from home-based primary care programs for homebound older adults.
        J Am Geriatr Soc. 2014; 62: 2243-2251
        • Schuchman M.
        • Fain M.
        • Cornwell T.
        The resurgence of home-based primary care models in the United States.
        Geriatrics (Basel). 2018; 3: 41
        • Rotenberg J.
        • Kinosian B.
        • Boling P.
        • Taler G.
        Independence at Home Learning Collaborative Writing Group. Home-based primary care: beyond extension of the independence at home demonstration.
        J Am Geriatr Soc. 2018; 66: 812-817
        • Zimmerman S.
        • Carder P.
        • Schwartz L.
        • et al.
        The imperative to reimagine assisted living.
        J Am Med Dir Assoc. 2022; 23: 225-234
        • Nazareno J.
        • Zhang W.
        • Silver B.
        • Dosa D.
        • Gozalo P.
        • Thomas K.
        Home health utilization in assisted living settings.
        Med Care Res Rev. 2020; 77: 620-629
        • Yao N.
        • Mutter J.B.
        • Berry J.D.
        • Yamanaka T.
        • Mohess D.T.
        • Cornwell T.
        In traditional Medicare, modest growth in the home care workforce largely driven by nurse practitioners.
        Health Aff (Millwood). 2021; 40: 478-486
        • Ritchie C.
        • Leff B.
        • Gallopyn N.
        • Pu C.
        • Sheehan O.
        Medical care at home comes of age. The California Health Care Foundation.
        • Yao N.
        • Ritchie C.
        • Camacho F.
        • Leff B.
        Geographic concentration of home-based medical care providers.
        Health Aff (Millwood). 2016; 35: 1404-1409
        • Ornstein K.A.
        • Leff B.
        • Covinsky K.E.
        • et al.
        Epidemiology of the homebound population in the United States.
        JAMA Intern Med. 2015; 175: 1180-1186
        • CMS
        Medicare provider utilization and payment data.
        • CMS
        Medicare geographic variation - by national, state & county.
        • CMS
        Chronic conditions.
        • The Commonwealth Fund aTSF
        Long-term services & supports state scorecard.
        http://www.longtermscorecard.org/
        Date accessed: November 9, 2021
      1. MACPAC. Dually eligible beneficiaries.
        • Colello K.J.
        Overview of assisted living facilities. The Congressional Research Service (CRS).
        • Colello K.J.
        Overview of long-term services and supports. The Congressional Research Service (CRS).
        • Fabius C.D.
        • Cornell P.Y.
        • Zhang W.H.
        • Thomas K.S.
        State Medicaid financing and access to large assisted living settings for Medicare-Medicaid dual-eligibles.
        Med Care Res Rev. 2022; 79: 69-77
        • Sairenji T.
        • Jetty A.
        • Peterson L.E.
        Shifting patterns of physician home visits.
        J Prim Care Comm Health. 2016; 7: 71-75

      Reference

        • Austin P.C.
        • Steyerberg E.W.
        The number of subjects per variable required in linear regression analyses.
        J Clin Epidemiol. 2015; 68: 627-636

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