Effects of Home-Based Primary Care on Hospital Use for High-Need Medicare Patients: an Observational Study

• Published in: Journal of general internal medicine : JGIM 2024, Vol.39 (1), p.19-26
• Main Authors: Kimmey, Laura, Wysocki, Andrea, Forrow, Lauren Vollmer, Anderson, Michael, Nyweide, David J.
• Format: Article
• Language: English
• Subjects: Aged; Expenditures; Government programs; Health care; Home Care Services; Hospitalization; Hospitals; Humans; Internal Medicine; Medicare; Medicine; Medicine & Public Health; Observational studies; Original Research; Patients; Primary care; Primary Health Care; Retrospective Studies; Statistical analysis; United States - epidemiology
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08328-8

Background High-need, high-cost Medicare patients can have difficulties accessing office-based primary care. Home-based primary care (HBPC) can reduce access barriers and allow a clinician to obtain valuable information not obtained during office visit, possibly leading to reductions in hospital use. Objective To determine whether HBPC for high-need, high-cost patients reduces hospitalizations and Medicare inpatient expenditures. Design We conducted a matched retrospective cohort study using a difference-in-differences analysis to examine patients 2 years before and 2 years after their first home visit (HBPC group). Participants The study included high-need, high-cost fee-for-service Medicare patients without prior HBPC use, of which 55,303 were new HBPC recipients and 156,142 were matched comparison patients. Intervention Receipt of at least two HBPC visits and, within 6 months of the index HBPC visit, a majority of a patient’s primary care visits in the home. Main Measures Total and potentially avoidable hospitalizations and Medicare inpatient expenditures. Key Results HBPC reduced total hospitalization rates, but the marginal effects were not statistically significant: a reduction of 11 total hospitalizations per 1000 patients in the first year (− 0.6%, p  = 0.19) and 14 in the second year (− 0.7%, p  = 0.16). However, HBPC reduced potentially avoidable hospitalization rates in the second year. The estimated marginal effect was a reduction of 6 potentially avoidable hospitalizations per 1000 patients in the first year (− 1.6%, p  = 0.16) and 11 in the second (− 3.1%, p  = 0.01). The estimated effect of HBPC was a small decrease in inpatient expenditures of $24 per patient per month (− 1.1%, p  = 0.10) in the first year and $0 (0.0%, p  = 0.99) in the second. Conclusions After high-need, high-cost patients started receiving HBPC, they did not experience fewer total hospitalizations or lower inpatient spending but may have had lower rates of potentially avoidable hospitalizations after 2 years.