Effects of Home-Based Primary Care on Hospital Use for High-Need Medicare Patients: An Observational Study
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Associated Project
Evaluation of the Independence at Home Demonstration
Prepared for:
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
Key Findings
- After high-need, high-cost patients started receiving home-based primary care, they did not experience fewer total hospitalizations or lower inpatient spending but may have had lower rates of potentially avoidable hospitalizations after two years.
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 two years before and two 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 six 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 1,000 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 1,000 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 two years.
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