Profit status of home health care agencies and the risk of hospitalization

Exploring performance profiles of home health care agencies: A two-stage analytical approach

BACKGROUND

Public reporting of home health care agencies' performance metrics, including patient satisfaction, care processes, and health outcomes, aims to inform customer decisions and encourage agencies to improve the quality of services. However, there is limited research that examines the heterogeneous performance of home health care agencies.

PURPOSES

The aim of this study was to analyze the performance of home health care agencies by identifying distinct subgroups of agencies with similar performance profiles and describing the relationships between agency characteristics and such subgroups.

METHODOLOGY/APPROACH

We propose a two-stage analytical approach employing unsupervised machine learning methods. First, clustering analysis is applied to performance measures, allowing the partitioning of agencies into homogeneous subgroups based on similarities in performance. Then, association rule mining is used to uncover the relationships between cluster assignments and agency characteristics.

RESULTS

The two-stage analytical approach identified four clusters with significantly different performance profiles and agency characteristics: cost-efficient agencies with high patient satisfaction (Cluster 1), high-cost agencies with high-quality care (Cluster 2), urban agencies with low patient satisfaction (Cluster 3), and small agencies with low-quality care (Cluster 4).

CONCLUSION

This study contributes to understanding agency performance in the U.S. home health care industry. By identifying distinct subgroups of agencies and understanding the factors influencing their performance, we can enhance home health care services' overall quality and effectiveness.

PRACTICE IMPLICATIONS

Our study uncovered diverse performance profiles and associated characteristics among home health care agencies, highlighting the need for tailored strategies and targeted interventions to improve the quality of care across clusters. Health care administrators and policymakers should consider cluster-specific recommendations.

The Effects of Home Health Value-Based Purchasing on Home Health Care Quality in For-Profit and Nonprofit Agencies: A Comparative Interrupted Time-Series Analysis, 2012-2018

Beginning in 2016, the Home Health Value-Based Purchasing (HHVBP) model incentivized U.S. Medicare-certified home health agencies (HHAs) in nine states to improve quality of patient care and patient experience. Here, we quantified HHVBP effects upon quality over time (2012-2018) by HHA ownership (i.e., for-profit vs. nonprofit) using a comparative interrupted time-series design. Our outcome measures were Care Quality and Patient Experience indices composed of 10 quality of patient care measures and five patient experience measures, respectively. Overall, 17.7% of HHAs participated in the HHVBP model of which 81.4% were for-profit ownership. Each year after implementation, HHVBP was associated with a 1.59 (p < .001) percentage point increase in the Care Quality index among for-profit HHAs and a 0.71 (p = .024) percentage point increase in the Patient Experience index among nonprofits. The differences of quality improvement under the HHVBP model by ownership indicate variations in HHA leadership responses to HHVBP.

Factors associated with homecare coordination and quality of care: a research protocol for a national multi-center cross-sectional study

INTRODUCTION

The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited.

OBJECTIVES

This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies' structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care.

DESIGN AND METHODS

This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees' working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses.

DISCUSSION

The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.

Causal analysis of the impact of homecare services on patient discharge disposition

This study uses observational causal inference to evaluate the impact of different combinations of home care services (nursing, therapies, social work, home aides) on end-of-episode disposition for individuals with chronic diseases associated with the circulatory, endocrine, and musculoskeletal systems. The potential to generate actionable recommendations for personalizing home care services, or treatment plans, from limited clinical and care needs data is demonstrated. For patients with chronic disease in the circulatory or musculoskeletal systems, a 2.91% and 3.38% decrease, respectively, in acute care hospitalization rates could be obtained by providing patients with therapy and nursing services, rather than therapy services alone.

Comparing Public Quality Ratings for Accredited and Nonaccredited Home Health Agencies

This was a descriptive study comparing 1,582 accredited and 10,008 nonaccredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid Services Home Health Compare data set. Metrics included the star rating and 22 quality measures. A longitudinal model was used to determine differences between accredited and nonaccredited organizations on the quality measures. Categorical differences in star ratings and risk-adjusted outcome categories were analyzed using a chi-square test. Accredited agencies had statistically higher star ratings than nonaccredited organizations (3.4 vs. 3.2, p < .001), and they were more likely to be categorized 4, 4.5, and 5 star organizations ( p < .001). Absolute differences between accredited and nonaccredited agencies on the OASIS quality measures were generally small but consistently favored accredited facilities over all 3 years studied ( p < .05).

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

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.

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

Introduction:

Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care.

Aim:

This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries.

Methods:

Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques.

Conclusions and Discussion:

These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

For-profit medicare home health agencies' costs appear higher and quality appears lower compared to nonprofit agencies

For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome "avoidance of hospitalization" (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare's market-oriented, risk-based home care payment system.

Who Rules Home Care? The Impact of Privatization on Profitability, Cost, and Quality

This article explores the literature, including two recent studies, on whether home health agency (HHA) ownership type plays a significant role in agency quality, cost, and profitability. The literature is limited, except for the two recent studies that use a merged database created from the Medicare Home Health Compare and the 2010 Medicare home health cost reports databases. One study found statistically significant differences between proprietary and non-profit HHAs: Proprietary agencies have lower overall quality, higher profitability, higher costs per patient, and more visits per patient, with therapy visits accounting for a larger share of the total. However, the second study found that the explanatory value of ownership is limited, with the number of HHAs in the state and therapy visits as a percentage of total visits having a significant influence on cost and quality when combined with ownership compared with ownership alone. Policy, practice, and research implications are discussed.

Are Consumers Satisfied With Medicare Home Health

This study is the first to examine how home health agency ownership and other determinants affect patient satisfaction with Medicare home health agency care. For the first time, data residing in three separate Medicare databases have been integrated for analysis. Multiple linear regression was used with independent variables that measure seven categories of home health agency characteristics and services: ownership type, costs, cost-related ratios, revenue, quality, years certified, and visits. Results show five variables statistically significant in a model predicting home health agency patient satisfaction; the two largest contributors are total home health costs and years of agency certification. The study gives policymakers and home health agencies insights into the key determinants of patient satisfaction and demonstrates the value of integrating multiple Medicare databases.

Hospitalization Among Medicare-Reimbursed Skilled Home Health Recipients

This article presents a summary and critique of the published empirical evidence between the years 2002 and 2011 regarding rehospitalization among Medicare-reimbursed, skilled home health recipients. The knowledge gained will be applied to a discussion regarding ACH among geriatric home health recipients and areas for future research. The referenced literature in MEDLINE, PubMed and Cochrane databases was searched using combinations of the following search terms: home care and home health and Medicare combined with acute care hospitalization, rehospitalization, hospitalization, and adverse events and limited to studies conducted in the United States. Twenty-five research studies published in the last eight years investigated hospitalization among patients receiving Medicare-reimbursed, skilled home health. Empirical findings indicate telehomecare can reduce hospitalizations and emergency room use. The identification of risk factors for hospitalization relate to an elder's sociodemographic, clinical and functional status that can be identified upon admission and interventions taken in order to reduce hospitalizations. Disease management, frontloading nurse visits, the structure of home health services and OBQI are also among the interventions identified to reduce hospitalizations. However, the body of evidence is limited by a paucity of research and the over reliance on small sample sizes. Few published studies have explored methods that effectively reduce hospitalization among Medicare-reimbursed skilled home health recipients. Further research is needed to clarify the most effective ways to structure home health services to maximize benefits and reduce hospitalization among this chronically ill geriatric population.