Characteristics of Home Health Care Episodes

Home health care has great potential to provide savings in other health care settings, but has aroused some controversy because of its penchant for attracting fraudulent providers.  Medicare has spent a significant amount of time trying to reconfigure reimbursement and other policies to maximize appropriateness of care, while limiting payment.  In response the Alliance for Home Health Quality and Innovation has released a series of reports designed to pinpoint home health care’s role in the overall care of Medicare beneficiaries and to demonstrate the value of such care.  The most recent of these reports looks at the timely topic of readmissions.   (AHHQI Report)   About 20% of beneficiaries are readmitted within 30 days of a hospital discharge and it is obvious that home health care might play a role in lowering that number.  The researchers looked at relationships among care settings before and after a hospital admission or readmission.

The data was collected from Medicare’s 5% claims database for 2007 to 2009.   The researchers examined use of home health as a post-acute care provider, a pre-acute care provider and a non-post-acute care community based provider.   Some general findings include that for post-acute episodes, about 78% had no readmission, 17% had one and 5% had two or more.  As might be expected, episodes with a readmission are twice as costly as those without.  Readmission rate varies by MS-DRG, with joint replacement at about 9.5% and 35% for heart failure.  More chronic conditions means a higher likelihood of readmissions, as does being a dual eligible, non-white or living alone.  Similar results were found for pre-acute care episodes.  The researchers found extensive geographic variation in readmission rates both in post and pre-acute care episodes and by MS-DRG, with as much as 3-fold geographic variation for some diagnostic groups.  The was some suggestion that receiving home health care might result in fewer readmissions.