Trends in Physician House Calls to Medicare Beneficiaries

Lars E. Peterson; Steven H. Landers; Andrew Bazemore

doi:10.3122/jabfm.2012.06.120046

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Table 1. Characteristics of Physicians by Provision of House Calls (HCs)

	2000		2003		2006
	Any HCs (n = 2,019)	No HCs (n = 24,546)	Any HCs (n = 1,768)	No HCs (n = 25,254)	Any HCs (n = 1,350)	No HCs (n = 24,584)
Age, mean years (SE)	48.62 (0.27)	47.18 (0.07)^*	49.75 (0.31)	47.98 (0.08)^*	51.51 (0.33)	48.95 (0.08)^*
Men (%)	86.38	81.53^*	82.65	79.00^*	79.49	76.92
Specialty (%)
Family physician	33.94	12.30^*	37.64	13.31^*	34.64	13.07^*
General internal medicine	34.30	13.96^*	32.42	14.38^*	38.18	14.53^*
General practitioner	6.04	1.75^*	4.82	1.24^*	4.46	0.85^*
Geriatrician	5.24	0.82^*	6.38	0.88^*	8.21	1.20^*
Other	20.47	71.17^*	18.74	70.19^*	14.50	70.35^*
MD	89.36	94.68^*	89.95	94.28^*	87.20	93.73^*
Solo practice	32.89	22.49^*	31.13	18.71^*	31.57	18.45^*

Values provided as percentages unless otherwise indicated.
↵* P < .05 for within-year comparisons.
SE, standard error.

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Table 2. Weighted Estimated in Trends in House Calls (HCs) by Physician Specialty, 2000–2006

	2000	2003	2006	Percent Change 2000 to 2006
Providers making at least one HC, % (SE)
Total	7.22 (0.20)	6.26 (0.20)	5.26 (0.19)	−27.15
Family physician	17.68 (0.78)	15.88 (0.76)	12.83 (0.73)	−27.43
General internal medicine	16.06 (0.75)	13.08 (0.73)	12.73 (0.75)	−20.73
General practice	21.16 (2.25)	20.61 (2.82)	22.58 (3.54)	6.71
Geriatricians	33.35 (3.49)	32.54 (3.43)	27.50 (3.10)	−17.54
Other	2.19 (0.14)	1.75 (0.14)	1.13 (0.11)	−48.40
HCs, n (95% CI^*)
Total	478,088 (346–611)	700,661 (407–995)	995,294 (657–1,333)	108.18
Family physician	117,525 (60–175)	95,540 (47–144)	173,373 (69–277)	47.52
General internal medicine	211,500 (106–317)	389,931 (113–667)	438,821 (191–687)	107.48
General practitioners	42,476 (−1 to 86)	62,287 (−4 to 128)	116,365 (−5 to 238)	173.96
Geriatricians	41,811 (14–70)	68,022 (22–114)	132,774 (31–234)	217.56
Other	64,775 (30–99)	84,881 (34–136)	133,961 (−12 to 280)	106.81
Patients receiving HCs, n (95% CI^*)
Total	164,825 (134–195)	218,703 (158–279)	282,526 (187–378)	71.41
Family physician	47,972 (30–66)	36,628 (25–48)	52,869 (26–79)	10.21
General internal medicine	59,993 (44–76)	99,052 (49–149)	122,833 (58–188)	104.75
General practice	15,127 (2–28)	23,221 (5–41)	28,574 (3–54)	88.89
Geriatricians	16,149 (8–24)	24,331 (10–38)	30,597 (13–48)	89.45
Other	25,584 (13–38)	35,471 (10–61)	47,653 (−12 to 107)	86.26

↵* In thousands.
SE, standard error; CI, confidence interval.

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Table 3. Provider and County Characteristics Associated with Making House Calls (HCs) and Being in the Top Decile of Physicians by Volume of HCs Made in 2006

	Any HCs (n = 1,350)	No HCs (n = 24,584)	Adjusted OR (95% CI)	High HC Physicians^* (n = 122)	Low HC Physicians (n = 1,228)	Adjusted OR (95% CI)
Physician level
Age, mean years (SE)	51.51 (0.33)	48.95 (0.08)^†	1.03 (1.02–1.04)	51.82 (0.99)	51.45 (0.36)	0.99 (0.95–1.03)
Male sex (%)	79.49	76.92	1.28 (1.00–1.62)	76.98	79.87	0.75 (0.33–1.68)
Specialty (%)
Family physician	34.64	13.07^†	0.99 (0.79–1.23)	22.58	36.55	0.89 (0.40–1.96)
General internal medicine	38.18	14.53^†	Ref	46.25	36.94	Ref
General practitioner	4.46	0.85^†	1.45 (0.78–2.71)	7.33	3.96	1.19 (0.14–10.18)
Geriatrician	8.21	1.20^†	2.41 (1.57–3.71)	15.33	7.11	1.50 (0.49–4.54)
Other	14.50	70.35^†	0.08 (0.07–0.11)	8.51	15.45	0.54 (0.24–1.20)
Solo practice	31.57	18.45^†	1.48 (1.18–1.86)	35.07	31.04	1.32 (0.60–2.89)
MD versus DO	87.20	93.73^†	0.64 (0.47–0.89)	85.06	87.53	0.43 (0.15–1.30)
County level
Proportion population 65 years or older	13.22	12.54	1.02 (0.99–1.05)	12.54	13.33	0.94 (0.84–1.04)
Physician-to- population ratio	28.77	31.50	0.98 (0.97–0.99)	32.74	28.15	1.03 (1.01–1.06)
PCP-to-population ratio	10.83	11.25	1.01 (0.97–1.04)	11.05	10.80	0.89 (0.78–1.00)
Medicare managed care penetration rate	13.18	14.43	0.99 (0.98–0.99)	16.05	12.74	1.01 (0.98–1.03)
Proportion of population in poverty	12.34	12.85	1.00 (0.98–1.02)	12.24	12.36	0.99 (0.95–1.04)
Rural/urban status
Metropolitan	82.58	89.01	0.78 (0.57–1.07)	93.62	80.79	3.05 (1.38–6.76)
Micropolitan	10.09	8.06	Ref	2.16	11.33	Ref
Rural	7.38	2.93	2.54 (1.75–3.67)	4.23	7.87	3.40 (1.04–11.09)
Region of practice
New England	8.08	6.22	2.28 (1.52–3.43)	4.26	8.67	0.41 (0.11–1.58)
Middle Atlantic	31.56	14.96	2.08 (1.74–2.48)	32.92	31.35	0.83 (0.57–1.22)
East North Central	17.73	16.63	1.56 (1.11–2.20)	18.52	17.61	0.94 (0.42–2.07)
West North Central	4.88	7.35	1.05 (0.72–1.52)	2.22	5.30	0.41 (0.15–1.14)
South Atlantic	13.20	19.65	Ref	15.43	12.85	Ref
East South Central	3.20	6.17	0.80 (0.52–1.24)	1.03	3.54	0.34 (0.09–1.27)
West South Central	5.22	9.74	0.89 (0.56–1.44)	4.30	5.37	0.58 (0.20–1.74)
Mountain	4.35	6.04	1.22 (0.81–1.86)	4.25	4.37	0.92 (0.20–4.18)
Pacific	11.78	13.23	1.68 (1.03–2.73)	17.07	10.95	1.07 (0.39–2.97)

↵* High HC physician is a physician who makes HCs in the top decile of HCs by volume.
↵† P = < .05.
Ref, reference category; PCP, Primary Care Physician.