Abstract
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.
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Data Availability
The data sets used to create the analysis file for the current study are available through a data use agreement with the Centers for Medicare & Medicaid Services.
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Acknowledgements:
The authors acknowledge the significant contributions to a predecessor of this study that were provided by the following former Mathematica employees: Valerie Cheh and Catherine McLaughlin.
Funding
This study was funded by the Centers for Medicare & Medicaid Services under contract number HHSM-500–2014-00034I/HHSM-500-T0018. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or any of its agencies.
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Kimmey, L., Wysocki, A., Forrow, L.V. et al. Effects of Home-Based Primary Care on Hospital Use for High-Need Medicare Patients: an Observational Study. J GEN INTERN MED 39, 19–26 (2024). https://doi.org/10.1007/s11606-023-08328-8
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DOI: https://doi.org/10.1007/s11606-023-08328-8