This article examines physician management of Medicare patients receiving home health services. Patients under Medicare home health generally have complex medical needs and make heavy use of health care services, but little is known about the extent and type of physician supervision provided to these patients. The authors compared data from the 2005 and 2006 Medicare 5% Standard Analytic Files against the Outcome and Assessment Information Set on Medicare home health recipients.

Key Findings:

• Almost 35 percent of home health patients did not receive any form of physician evaluation and management during their home health episode. Patients who entered home health services from the community were more likely (52%) to not receive any physician supervision than patients entering home health from acute care or physician management settings.
• Home health patients were most likely to receive physician care exclusively in physician offices (52%) or in combination with consultations. Only 3 percent of patients received house calls exclusively. Patients who received physician house calls were disproportionately likely to be older, frail and disoriented.
• Patients who received physician supervision were more likely to be discharged from home health (78%) than patients who did not receive physician supervision (71%).

Medicare calls for physician evaluation and supervision for all home health patients. However, a large percentage of home health patients receive no physician supervision for the duration of their use of home health services, suggesting that a fragile and medically complex population is not receiving optimal care.