Time Providing Care Outside Visits in a Home-Based Primary Care Program

Objectives To assess how much time physicians in a large home-based primary care (HBPC) program spend providing care outside of home visits. Unreimbursed time and patient and provider-related factors that may contribute to that time were considered. Design Mount Sinai Visiting Doctors (MSVD) providers filled out research forms for every interaction involving care provision outside of home visits. Data collected included length of interaction, mode, nature, and with whom the interaction was for 3weeks. Setting MSVD, an academic home-visit program in Manhattan, New York. Participants All primary care physicians (PCPs) in MSVD (n=14) agreed to participate. Measurements Time data were analyzed using a comprehensive estimate and conservative estimates to quantify unbillable time. Results Data on 1,151 interactions for 537 patients were collected. An average 8.2h/wk was spent providing nonhome visit care for a full-time provider. Using the most conservative estimates, 3.6h/wk was estimated to be unreimbursed per full-time provider. No significant differences in interaction times were found between patients with and without dementia, new and established patients, and primary-panel and covered patients. Conclusion Home-based primary care providers spend substantial time providing care outside home visits, much of which goes unrecognized in the current reimbursement system. These findings may help guide practice development and creation of new payment systems for HBPC and similar models of care.