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Physician Evaluation and Management of Medicare Home Health Patients

Wolff, Jennifer L. PhD*†‡; Meadow, Ann ScD‡; Boyd, Cynthia M. MD, MPH*†; Weiss, Carlos O. MD, MHS†; Leff, Bruce MD*†

doi: 10.1097/MLR.0b013e3181b58e30
Original Article

Objective: The Medicare home health benefit is predicated on physician referral and involvement. In this study, we investigated (1) the frequency and (2) implications of home health patients’ evaluation and management by community physicians.

Methods: The 2005 and 2006 Medicare 5% Standard Analytic Files were linked to the Outcome and Assessment Information Set to examine physician visits among 74,462 fee-for service Medicare beneficiaries with a home health episode of care between July 1, 2005 and December 1, 2006. We examined whether receipt of community physician evaluation and management visits by home health patients was associated with subsequent discharge disposition, comparing discharge from the agency as opposed to inpatient facility transfer.

Results: More than one-third (34.6%) of patients did not receive physician evaluation and management visits during their home health episode. Home health patients most commonly incurred physician office visits exclusively (51.5%) or in combination with consultations (6.8%) or house call visits (2.2%), as well as house call visits exclusively (3.3%). Patients who incurred physician evaluation and management visits during their episode of care were more likely to be discharged from home health agencies than their counterparts who did not (77.9% vs. 70.6%, respectively). The association between physician visits and home health discharge was statistically significant in both simple regression models (odds ratio = 1.47; 95% confidence interval [CI], 1.42–1.52) and in multivariate analyses accounting for socio-demographic factors, health, and functioning (odds ratio = 1.45; 95% CI, 1.40–1.51).

Conclusions: More systematic integration of physicians in home care processes may reduce subsequent hospital and other inpatient facility use among home health patients.

From the *Department of Health Policy and Management, Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; and ‡Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, MD.

Supported by the Robert Wood Johnson Amos Medical Faculty Development Program (to C.O.W.).

This manuscript was developed through the course of an Intergovernmental Personnel Agreement supporting Jennifer Wolff at the Centers for Medicare and Medicaid Services (No. 9223).

Findings from earlier versions of this manuscript were presented at the annual meeting of Academy Health in Washington DC in June 2008.

Dr. Boyd was a Robert Wood Johnson Physician Faculty Scholar and a Bayview Scholar at the Johns Hopkins Center for Innovative Medicine.

Dr. Weiss was supported by the Robert Wood Johnson Amos Medical Faculty Developement Program.

Reprints: Jennifer L. Wolff, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD 21205. E-mail: jwolff@jhsph.edu.

© 2009 Lippincott Williams & Wilkins, Inc.