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Physician home visits increasing, lowering cost of high-quality care

Family physicians and general internists making home and domiciliary visits shows promise in lowering medical costs while providing high-quality care, and visits to Medicare beneficiaries are increasing, according to data published in the Journal of Primary Care and Community Health.

“Home visits are a patient-centered health care delivery model that aligns with the Triple Aim: Improving population health, reducing costs and improving quality through patient experience and satisfaction,” Tomoko Sairenji, MD, MS, of the University of Washington, in Seattle, and colleagues wrote. “… Various home visit-based health care delivery models demonstrated decreases in risk of functional decline, hospitalizations and hospital length of stay, skilled nursing facility placement and emergency room visits. By targeting frail, high-cost patients with multiple chronic conditions, some home visits programs have shown significant decreases in health care costs.”

To determine the trends in physician home and domiciliary visit prevalence among Medicare patients, and the common characteristics of these physicians, the researchers used a state-weighted sample of the direct patient care physicians in the 2007 AMA Masterfile.

In addition, they submitted a request to CMS for the claims data of all Medicare beneficiaries who had been seen at least once by the physicians in the sample in 2006 and in 2011. The sample included 22,186 physicians. The researchers used descriptive statistics to characterize physicians in the sample, and to find the numbers of total home and domiciliary visits by physician specialty

According to the researchers, there were 689 physicians who had stopped, and 503 physicians who had started, performing home visits between 2006 and 2011. For domiciliary visits, 261 stopped, and 290 started, during that time. In addition, from 2006 to 2011, the number of physicians billing Medicare for at least one home visit decreased from 5.1% to 4.5%, while those billing for domiciliary visits increased from 2% to 2.3%. Physicians including in the sample billed Medicare for 39,068 home visits, and 33,057 domiciliary care visits, in 2006. In 2011, home visits increased 6.9%, to 35,379, and domiciliary care visits increased 30%, to 45,299. Physicians who performed home visits were more likely to be older, located in rural communities, specialized in primary care, and more likely to provide nursing home and domiciliary care compared with those who do not make home visits (P < .05).

“Policies such as the Independence at Home Demonstration showed cost savings with improved quality metrics, and it is clear that societal need for this model of care is increasing,” Sairenji and colleagues wrote. “Educating the upcoming generation of physicians to make or lead home visits and supporting physicians who provide this service will likely benefit both our patients and the health care system overall.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.