Time providing care outside visits in a home-based primary care program.

Area of Science:

• Geriatrics
• Primary Care Medicine
• Health Services Research

Background:

• Home-based primary care (HBPC) programs provide essential services to patients unable to visit clinics.
• The time physicians spend on care outside of direct home visits is often not fully reimbursed or recognized.
• Understanding this "non-visit" time is crucial for program sustainability and physician well-being.

Purpose of the Study:

• To quantify the time physicians in a large HBPC program spend on activities outside of home visits.
• To identify patient and provider factors associated with this non-visit care time.
• To assess the extent of unreimbursed time within the HBPC model.

Main Methods:

• Physicians in the Mount Sinai Visiting Doctors (MSVD) program tracked all interactions outside of home visits for three weeks.
• Data collected included interaction duration, mode, nature, and participants.
• Time data were analyzed using comprehensive and conservative estimates to determine unbillable hours.

Main Results:

• An average of 8.2 hours per week per full-time provider was spent on non-home visit care.
• Conservative estimates indicated approximately 3.6 hours per week per full-time provider were unreimbursed.
• No significant differences in interaction time were observed based on patient diagnoses (e.g., dementia) or patient status (new vs. established).

Conclusions:

• Physicians in HBPC dedicate a substantial amount of time to care beyond direct home visits.
• A significant portion of this non-visit time is unreimbursed, posing challenges to current payment models.
• Findings suggest a need for revised reimbursement structures to adequately compensate HBPC providers for their comprehensive care efforts.