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Original research| Volume 99, ISSUE 6, P1090-1098.e4, June 2018

Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions

Published:September 21, 2017DOI:https://doi.org/10.1016/j.apmr.2017.08.483

      Abstract

      Objective

      To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.

      Design

      Retrospective analysis.

      Setting

      Home health agencies.

      Participants

      Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.

      Interventions

      Not applicable.

      Main Outcome Measures

      Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.

      Results

      Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28).

      Conclusions

      As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.

      Keywords

      List of abbreviations:

      CMS (Centers for Medicare & Medicaid Services), HHA (Home health agency), HRR (Hospital referral region), OASIS (Outcome and Assessment Information Set)
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