The U.S. faces a critical shortage of doctors and other healthcare practitioners willing to make house calls to as many as 4 million frail, homebound Americans, a new study shows.

The healthcare workforce has yet to adapt to the needs of older Americans who increasingly choose to age at home rather than in nursing facilities, the report finds.

The Health Affairs study is one of the first to examine the use of home-based medical care in the U.S.

“This paper really shows us that access to home-based healthcare is extremely limited, highly concentrated and just not available to all who need it,” said Katherine Ornstein, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York, in a phone interview. Ornstein was not involved with the new study.

In 2010, at least 53 percent of Americans lived more than 30 miles away from full-time providers of home-based medical care, the research shows. Some states, including many in the Midwest, had no healthcare professionals who made 500 or more home visits a year.

Researchers used 2012 and 2013 Medicare payment data to identify healthcare professionals’ home-based medical visits and examined workforce and geographic variations.

Only about 470 primary-care providers, or about 9 percent of them, appeared to devote their practices to visiting patients at home. They performed nearly half of 1.7 million home visits in 2012 and 2013, averaged about 1,600 house calls a year and were paid about $167,000 annually by Medicare, the study found.

Although prior research has shown that more frail Americans live at home than in nursing homes, seven times more primary-care doctors visited nursing homes than made house calls, the study found.

Internal medicine physicians made about 8 million nursing-facility visits, compared to about 500,000 home visits in 2012, the data showed. Medicare paid them $500 million for nursing facility visits, compared to $50 million for home visits.

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“The pattern of care doesn’t match the size of the population,” Ornstein said. “Not only doesn’t it match – it’s way off.”

“We’re in this exciting time of health-care reform, and we have to develop new service-delivery models,” she said.

Doctors visited patients at home for generations, Nengliang (Aaron) Yao, the study’s lead author, told Reuters Health.

Yao, a health-policy professor at the University of Virginia School of Medicine in Charlottesville, added, “This is not a new model. This is an old model. In the old days, the doctor went to visit patients’ homes on horseback.”

Doctors discover details about patients’ needs during home visits that they are unlikely to see in an office setting, Yao said. One geriatrician told him a home visit revealed that a patient required no medical intervention, just an air conditioner.

“I’ve talked to many home-care medical providers,” Yao said. “They’re happy because they really feel they help their patients.”

Yao envisions a new medical specialty: home-based elder care.

The combination of longer life spans and aging baby boomers is expected to bring the number of older adults to an unprecedented 20 percent of the U.S. population by 2030, according to the federal Centers for Disease Control and Prevention.