The Changing Landscape of the Providers of Home-Based Medical Care in Traditional Medicare

As more older adults become homebound, home-based medical care (HBMC) has increased, but little is known about the HBMC workforce. This study analyzes national data on the size and structural features of HBMC providers from 2016 to 2022.

We analyzed annual primary care data for all traditional Medicare enrollees, classifying visits as HBMC (private residence or assisted living facility [ALF]) or non-HBMC (office or telemedicine). We evaluated trends in HBMC providers and visits by HBMC practice exclusivity (only-HBMC or both HBMC and non-HBMC), care setting (private residence, ALF), provider type (physician, nurse practitioner [NP], physician assistant [PA]), and visit volume. We assessed geographic variation in HBMC's share of primary care and payment differences between HBMC and non-HBMC services.

In 2022, 16,125 of 304,326 (5%) primary care clinicians delivered 5.6 million HBMC visits, with most visits (66%) in ALFs. From 2016 to 2022, HBMC providers increased by 40% and visits by 29%. The proportion of only-HBMC providers rose from 50.2% to 61.7%, whereas providers with volume > 1000 visits/year fell from 46.8% to 38.9%. The increase in providers was higher in private residences (49%) than ALFs (33%), though average provider volume decreased in private residences (-24%) and rose in ALFs (7%). NPs among HBMC providers increased from 42.2% to 63.0%, PAs from 6.6% to 8.2%, and physicians dropped from 51.3% to 28.9%. HBMC's share of all visits increased from 3.9% to 5.4%, driven more by ALF visits. Non-HBMC service payments grew faster than those for HBMC services.

Against the backdrop of an expanding HBMC workforce and rising visit volumes from 2016 to 2022, our findings highlight significant shifts in the structural composition of providers. These shifts emphasize the need for ongoing research to address their implications for access, quality, and outcomes in homebound older adults.