Author:
Ankuda Claire K.,Ornstein Katherine A.,Leff Bruce,Rajagopalan Subashini,Kinosian Bruce,Brody Abraham A.,Ritchie Christine S.
Abstract
AbstractBackgroundAs more Americans age in place, it is critical to understand care delivery in the home. However, data on the range of home-based services provided by Medicare is limited. We define a taxonomy of clinical care in the home funded through fee-for-service Medicare and methods to identify receipt of those services.MethodsWe analyzed Fee-for-service (FFS) Medicare claims data from a nationally-representative cohort of older adults, the National Health and Aging Trends Study (NHATS), to identify home-based clinical care. We included 6,664 NHATS enrollees age ≥ 70 and living in the community, observed an average of 3 times each on claims-linked NHATS surveys. We examined provider and service type of home-based clinical care to identify a taxonomy of 5 types: home-based medical care (physician, physician assistant, or nurse practitioner visits), home-based podiatry, skilled home health care (SHHC), hospice, and other fee-for-service (FFS) home-based care. We further characterized home-based clinical care by detailed care setting and visit types.ResultsFrom 2011–2016, 17.8%-20.8% of FFS Medicare beneficiaries age ≥ 70 received Medicare-funded home-based clinical care. SHHC was the most common service (12.8%-16.1%), followed by other FFS home-based care (5.5%-6.5%), home-based medical care (3.2%-3.9%), and hospice (2.6%-3.0%). Examination of the other-FFS home-based care revealed imaging/diagnostics and laboratory testing to be the most common service.ConclusionsWe define a taxonomy of clinical care provided in the home, serving 1 in 5 FFS Medicare beneficiaries. This approach can be used to identify and address research and clinical care gaps in home-based clinical care delivery.
Funder
National Institute on Aging
Publisher
Springer Science and Business Media LLC
Reference30 articles.
1. Spillman BC, Liu K, McGilliard C. Trends in residential long-term care: use of nursing homes and assisted living and characteristics of facilities and residents. U.S. Department of health and human services office of disability AaL-TCP; 2002. p. 1–2.
2. Cornell PY, Zhang W, Thomas KS. Changes in long-term care markets: assisted living supply and the prevalence of low-care residents in nursing homes. J Am Med Dir Assoc. 2020;21(8):1161-5.e4.
3. Toth M, Martin Palmer LA, Bercaw LE, Voltmer H, Karon S. Trends in the use of Residential Settings among Older Adults Issue Brief. ASPE; 2020.
4. Ryan J, Edwards BC. Rebalancing medicaid long-term services and supports. Health Aff. 2015;17:2015.
5. Teno JM, Gozalo P, Trivedi AN, Bunker J, Lima J, Ogarek J, et al. Site of death, place of care, and health care transitions among US medicare beneficiaries, 2000–2015. JAMA. 2018;320(3):264–71.
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献