Document Type
Article
Original Publication Date
2017
Journal/Book/Conference Title
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
Volume
65
Issue
4
First Page
847
Last Page
852
DOI
10.1111/jgs.14698
Date of Submission
June 2017
Abstract
Objectives
Residence-based primary care provides homebound frail patients with a care plan that is individually tailored to manage multiple chronic conditions and functional limitations using a variety of resources. We (1) examine the visit volume and Medicare payments for residence-based health care provided by nurse practitioners (NPs) in the Medicare fee-for-service environment; (2) compare NP's residential visits to those of internists and family physicians; and (3) compare the geographical service area of full-time house call NPs versus NPs who make nursing facility visits a major portion of their work.
Design
An observational study using secondary data.
Setting
Medicare Provider Utilization and Payment Data.
Participants
Medicare beneficiaries.
Measurements
Medicare payments for home and domiciliary care visits, the number of residence-based medical visits, provider volume, geographical distribution of full-time house call providers.
Results
About 3,300 NPs performed over 1.1 million home and domiciliary care visits in 2013, accounting for 22% of all residential visits to Medicare fee-for-service beneficiaries. A total of 310 NPs individually made more than 1,000 residential visits (defined as a full-time house call provider); among full-time house call providers, including physicians, NPs are now the most common provider type. There are substantial variations in the geographic distribution of full-time house call NPs, internists, and family physicians. Full time NP's service area is about 30% larger than family physicians and internists. Nursing home residents are far more likely to receive NP visits than are homebound persons receiving home visits.
Conclusion
NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area. However, the vast majority of frail Americans are more likely to receive NP's care in a nursing facility versus at home.
Rights
© 2016, Copyright the Authors
Is Part Of
VCU School of Nursing Publications
Supplementary Figure S1. Comparison of Physicians’ Nursing Facility Visits and Residential Visits
jgs14698-sup-0002-TableS1.docx (52 kB)
Supplementary Table S1. Service Mix of Nurse Practitioners who Make Home Care Visits
Comments
Originally published at http://doi.org/10.1111/jgs.14698