title: Increasing Role of Nurse Practitioners in House Call Programs.
abstract: OBJECTIVE
  Residence-based primary care provides homebound frail patients with a care plan that is individually tailored to manage multiple chronic conditions and functional limitations using a variety of resources. We (1) examine the visit volume and Medicare payments for residence-based health care provided by nurse practitioners (NPs) in the Medicare fee-for-service environment; (2) compare NP's residential visits to those of internists and family physicians; and (3) compare the geographical service area of full-time house call NPs versus NPs who make nursing facility visits a major portion of their work.
  
  
  METHODS
  An observational study using secondary data.
  
  
  METHODS
  Medicare Provider Utilization and Payment Data.
  
  
  METHODS
  Medicare beneficiaries.
  
  
  METHODS
  Medicare payments for home and domiciliary care visits, the number of residence-based medical visits, provider volume, geographical distribution of full-time house call providers.
  
  
  RESULTS
  About 3,300 NPs performed over 1.1 million home and domiciliary care visits in 2013, accounting for 22% of all residential visits to Medicare fee-for-service beneficiaries. A total of 310 NPs individually made more than 1,000 residential visits (defined as a full-time house call provider); among full-time house call providers, including physicians, NPs are now the most common provider type. There are substantial variations in the geographic distribution of full-time house call NPs, internists, and family physicians. Full time NP's service area is about 30% larger than family physicians and internists. Nursing home residents are far more likely to receive NP visits than are homebound persons receiving home visits.
  
  
  CONCLUSIONS
  NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area. However, the vast majority of frail Americans are more likely to receive NP's care in a nursing facility versus at home.
authors.affiliation: Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
authors.forename: Nengliang Aaron
authors.initials: NA
authors.lastname: Yao
authors.affiliation: College of Nursing, The University of Tennessee Knoxville, Knoxville, Tennessee.
authors.forename: Karen
authors.initials: K
authors.lastname: Rose
authors.affiliation: School of Nursing, University of Virginia, Charlottesville, Virginia.
authors.forename: Virginia
authors.initials: V
authors.lastname: LeBaron
authors.affiliation: Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.affiliation: Division of Geriatric Medicine, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Peter
authors.initials: P
authors.lastname: Boling
mesh_terms: D000368:Aged; D005260:Female; D005851:Geriatric Nursing; D006792:House Calls / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D009722:Nurse Practitioners; D024802:Nurse's Role; D014481:United States
keywords: healthcare workforce; house call; nurse practitioners