Increasing Role of Nurse Practitioners in House Call Programs

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.