A CMS evaluation linked larger reductions in potentially avoidable admissions among new home-based primary care users to practices where nurse practitioners or physician assistants conducted at least half of visits. It also linked reductions to home visits by nurses, social workers and chaplains, and to smaller clinician caseloads and patient panels.
Nurse practitioners and physician assistants had a substantial role
In its Independence at Home evaluation, the Centers for Medicare & Medicaid Services identified having nurse practitioners or physician assistants conduct at least half of home-based primary care visits as a practice associated with larger reductions in potentially avoidable admissions for new users.
That finding points to the share of visits delivered by these clinicians, not simply whether a practice employs an NP or PA. CMS grouped this visit pattern with other practices related to larger reductions. The evaluation describes an association, not a guarantee that changing a team's visit mix will reduce admissions.
Nurses, social workers and chaplains made home visits
CMS also linked larger reductions to visits in the home by non-physician staff, including nurses, social workers and chaplains. The report names these roles as part of the practice pattern, without ranking one role above another.
For practice owners, a concrete takeaway is to review which non-physician staff make home visits and how often. Tracking that alongside the NP and PA share of visits can help a team compare its current approach with the patterns CMS described.
Smaller caseloads and panels were part of the pattern
The CMS evaluation also associated larger reductions in potentially avoidable admissions for new users with lower daily clinician caseloads: 3 to 7 patients per day rather than 8 to 15. Smaller clinical panels were also linked to larger reductions: 40 to 149 patients per clinician rather than 150 to 200.
These figures describe the caseload and panel sizes associated with larger reductions in the evaluation. They add operating context to the team role findings, but do not identify a single staffing formula for every home-based primary care practice.
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
What team structure did practices in Independence at Home have to provide?
CMS says participating practices had to have experience delivering home-based primary care, staff available at all hours, and teams led by physicians or nurse practitioners. The practices largely kept their existing approach during the demonstration.
Did the evaluation identify visits outside the home as part of the pattern?
Yes. CMS included visits when needed in settings outside the home, such as a skilled nursing facility or hospital, among the practices related to larger reductions in potentially avoidable admissions for new users.
Did participating practices use frequent home visits?
The CMS final evaluation says practices had provided home-based primary care for years before the demonstration began in 2012 and continued approaches such as frequent home visits to identify problems before they worsened.
Sources
- Independence at Home Tenth and Final Evaluation Report Demonstration Years 1-10 (2012-2023) (Centers for Medicare & Medicaid Services)
- Independence at Home Demonstration - Final Evaluation Report Executive Summary (Centers for Medicare & Medicaid Services)
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