NEW YORK -Three health maintenance organizations (HMOs) were able to provide more primary care for elderly adults in nursing homes than traditional fee-for-service plans, which in turn cut down on hospitalizations and emergency room visits by HMO members, according to a study by researchers at the University of California, Los Angeles.
Dr. David Reuben and colleagues examined the way in which three unnamed HMOs provided care to elderly patients in nursing homes in three different regions of the country. The researchers compared care received by 215 HMO members in 20 nursing homes with 187 residents in the same nursing homes who relied on fee-for-service plans.
In each nursing home, the HMO members received about twice as many visits by health professionals as did the fee-for-service residents.
Each of the three HMOs provided care somewhat differently, but each utilized nurse practitioners or physician’s assistants to augment regular visits by physicians. As a result, in each of the nursing homes studied, HMO nursing home residents received more primary care visits than did residents who were not enrolled in an HMO.
The increased number of visits also appeared to reduce the number of visits to emergency departments and hospitalization by HMO members compared with residents in the same nursing homes who were reimbursed by fee-for-service Medicare. The HMO that provided the most total visits had a significantly lower percentage of residents transferred to emergency departments (6% versus 16%) and fewer hospitalizations per resident.
In addition, HMO residents who suffered from acute problems such as fevers or falls generally received more prompt and better documented care than fee-for-service residents, according to the study.
The researchers suggest that the success of the three HMOs in treating their older members in nursing homes depended on frequent physician visits and close supervision to monitor illnesses that might otherwise require hospitalization, regular visits by nurse practitioners, and a creative approach to assigning physicians to care for elderly nursing home residents. The most successful HMO program had established a core group of four physicians who only cared for nursing home residents and did not provide hospital or office-based care.
The researchers acknowledge that their study had many limitations and the results should not be interpreted generally to mean HMOs provide better care than fee-for-service plans. The study included only three HMOs that are among the “vanguard in providing primary care programs to long-stay nursing home residents,” the researchers wrote. Many HMOs do not have primary care plans designed specifically for nursing home residents, so these results should not be generalized to all HMOs.
“Our data suggest that (programs that provide intensive primary care to nursing home residents) are effective only when additional medical care, including frequent physician visits, is provided at the nursing home. Some gaps, most notably the inability to provide some tests and specialty visits on-site, coupled with the lack of coverage for transportation to clinical sites, still remain important obstacles to comprehensive care,” the study authors conclude.
SOURCE: Journal of the American Geriatrics Society 1999; 47:131-138.