News: Homebound seniors have higher Medicare spending than non-homebound, study finds

Homebound seniors use hospital-based care more and outpatient care less than non-homebound seniors, resulting in higher Medicare spending, a new research article published in the Journal of General Internal Medicine found. Data for the study was collected from the National Health and Aging Trends Study, which interviewed nearly 6,500 adults aged 70 years or older with Medicare fee-for-service coverage annually. Results showed about 40% of homebound seniors had a hospitalization annually, whereas 20% of non-homebound seniors did. Homebound was defined in the study as leaving home once per week or less, which makes up about two million seniors in the country, Healthleaders reported.

From the data, gathered from 2011 to 2017, the study also found the following:

• Annual Medicare spending for a homebound senior was $11,000 higher than non-homebound
• The homebound population was more likely to have a potentially preventable hospitalization (14.8% versus 4.5%)
• The homebound were also more likely to have an emergency room visit (54% versus 32.6%)
• Homebound seniors made up 5.7% of the Medicare fee-for-service patient population but accounted for 11% of total Medicare fee-for-service spending.

Despite this, homebound status was associated with a decreased likelihood of having an annual primary care or specialist visit, so home-based primary care would likely benefit homebound seniors and decrease Medicare spending, the study’s co-authors wrote.

“The lower rate of primary care utilization we observe may partially explain our finding that the homebound experience more potentially preventable hospitalizations than the non-homebound and higher spending,” they said. “Previous research suggests increasing access to home-based primary care may lower hospitalizations and overall spending for the homebound, depending on the intervention type.”

Telemedicine may help but it has limitations, particularly for this patient population, from a lack of broadband access, a lack of support and help using the technology, or cognitive and sensory impairments. “Our findings suggest that the homebound, a group often invisible to the healthcare system, may be an important population to target for quality improvement and to reduce Medicare spending,” the researchers said.

Editor’s note: To read Healthleader’s coverage of this story, click here. To read the published study, click here.