Increasing Role of Nurse Practitioners in House Call Programs

Area of Science:

• Gerontology
• Health Services Research
• Primary Care

Background:

• Residence-based primary care is crucial for managing chronic conditions in homebound, frail patients.
• Nurse practitioners (NPs) play a significant role in delivering this care.
• Understanding NP utilization and payment in Medicare is essential for optimizing care delivery.

Purpose of the Study:

• To examine visit volume and Medicare payments for NP-provided residence-based healthcare.
• To compare NP residential visits with those of internists and family physicians.
• To compare the geographical service areas of full-time house call NPs and those focusing on nursing facility visits.

Main Methods:

• Observational study utilizing secondary data from Medicare Provider Utilization and Payment Data.
• Analysis of Medicare beneficiaries receiving home and domiciliary care.
• Examination of provider volume, Medicare payments, and geographical distribution of services.

Main Results:

• Approximately 3,300 NPs conducted over 1.1 million home visits in 2013, representing 22% of all Medicare fee-for-service residential visits.
• NPs are the most common provider type among full-time house call providers (≥1,000 visits/year).
• Full-time NPs serve a geographical area 30% larger than internists and family physicians, but nursing home residents are more likely to receive NP visits than homebound individuals.

Conclusions:

• Nurse practitioners are the predominant provider type for residence-based care, covering the most extensive geographical areas.
• Despite their broad reach, the majority of frail Americans receive NP care in nursing facilities, not their homes.
• Further research is needed to understand and address disparities in home-based NP care access for the frail elderly population.