Income Level, Race Tied to Worse Home Health Outcomes

Medicare home health care beneficiaries are likely to have worse outcomes if they are poor, black or dually eligible for Medicare and Medicaid, according to a findings published in the Journal of the American Geriatrics Society.

The study looked at the 30- and 60-day clinical outcomes for home health Medicare beneficiaries from 2012 to 2014.

“We found that poor and black beneficiaries were more likely to be readmitted and have more frequent emergency department (ED) use,” study author Karen Joynt Maddox, MD, MPH, told HHCN. “Outcomes for all poor and black beneficiaries had worse outcomes than their non-poor and non-black counterparts.”


Maddox is an assistant professor at the Washington University School of Medicine in St. Louis (pictured above).

The outcomes were worse for dually eligible beneficiaries—those who qualify for both Medicare and Medicaid—with 15% to 20% higher odds of using the ED while they were in home health care, according to Maddox.

“The takeaway is there there are clinical disparities for individuals that largely mirror patterns in other health care settings,” she said.


Value-based purchasing implications

The findings have implications particularly for home health care providers under the nine-state value-based purchasing initiative, which ties reimbursement rates to outcomes.

The worry is that home health care agencies could start to turn away certain patients under value-based purchasing, knowing that individuals with high social risk factors could affect quality measures and put reimbursement rates at risk.

“My personal feeling—not that of the Health and Human Services Department—is that if you’re going to compare performance of providers, you’re going to need to adjust for social risk. It matters,” Maddox said.

However, there is some risk with adjusting rates based on social characteristics as well.

“The concern is that if you adjust, you’ll say it’s okay that poor people have higher readmission rates,” she explained.

Written by Amy Baxter

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