Defining a taxonomy of Medicare-funded home-based clinical care using claims data

BMC Health Services Research

Research

Claire K. Ankuda¹  Katherine A. Ornstein¹  Subashini Rajagopalan¹  Bruce Leff²  Bruce Kinosian³  Abraham A. Brody⁴  Christine S. Ritchie⁵ 

[1] Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA;Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA;Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA;Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, NY, USA;NYU Grossman School of Medicine, New York, NY, USA;Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, USA;

关键词: Geriatrics;    Home-based care;    Medicare;    Home health;   

DOI  :  10.1186/s12913-023-09081-8

 received in 2022-01-05, accepted in 2023-01-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAs 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.

【 授权许可】

CC BY   
© The Author(s) 2023

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