Primary Care Provided at Home Doesn’t Reduce Hospital Use, Study Finds

Primary care delivered to high-need, high-cost Medicare patients in their homes rather than in a doctor’s office reduced potentially avoidable hospitalizations by a small amount across the United States, but it did not reduce total hospitalizations or inpatient spending, according to findings from Mathematica’s Laura Kimmey and her coauthors in a new article in the Journal of General Internal Medicine.

Visiting patients where they live, especially those with complex conditions who face difficulty leaving their homes, can increase access to care and allow clinicians to better understand patients’ environments and needs. Proponents argue this could prevent hospitalizations, save money, and improve overall quality of care and quality of life.

Despite the increased demand for house calls as the number of homebound older adults has grown, evidence of its impact has not been clear. Reports of its success are often from studies with weak research designs. Stronger evidence comes from a few studies of single standardized programs that specialize in home-based primary care, even though many house calls come from clinicians who do not specialize in this type of care.

The study for this article is unique in its examination of all clinicians providing home-based primary care to their fee-for-service Medicare patients, not just those participating in specialized home-based primary care programs. Findings suggest that home-based primary care, in general, has not reduced hospitalizations for high-need, high-cost patients.

“Modern day house calls have yet to achieve their promise,” said Laura Kimmey, lead author of the article and a principal researcher at Mathematica. “Simply providing primary care to someone in their home doesn’t reduce total hospitalizations. We need to figure out what aspects of specialized home-based primary care programs are most likely to lead to improved outcomes for the growing number of people who are expected to be homebound because of frailty or disability.”

The Centers for Medicare & Medicaid Services is helping answer these questions through the Independence at Home Demonstration, which is testing the effect of a payment incentive and service delivery model for providing home-based primary care. Mathematica’s evaluation of Independence at Home is determining whether—and if so, how—the participating practices are achieving success. Results have shown relatively limited impacts, but patients and their caregivers reported high levels of satisfaction with home-based primary care.