The quality of home health care improved across most major domains between 2016 and 2017, although the rate of hospital admissions remained static for the fifth straight year.
That’s according to data in the Home Health Chartbook 2018, prepared by Avalere Health for the Alliance for Home Health Quality and Innovation.
The document compiles data from a variety of sources, including the Centers for Medicare & Medicaid Services’ Home Health Compare website. Across nine quality domains tracked on Compare, national averages for patient outcomes improved for eight. The greatest improvement came in the “got better at getting in and out of bed” measure, which ticked up from 62% in 2016 to 68% in 2017.
There was no change in the “had to be admitted to hospital” measure, which has remained at 16% since 2013.
However, there was a notable improvement in 30-day readmission rates for patients who received a hip or knee replacement and who also had multiple chronic conditions. The rate dropped from 9.9% in 2016 to 8.4% in 2017. In the same time period, the rate dropped from 17% to 16.6% for those patients who were receiving care in a skilled nursing facility (SNFs).
Readmissions within 30 days ticked up slightly for major joint replacement patients without multiple chronic conditions. In home health, the readmission rate rose from 3.9% in 2016 to 4.0% in 2017, while in SNFs it rose from 7.0% to 7.2%.
As an industry, home health’s economic contributions have also grown significantly. Total estimated home health expenditures for 2016 reached nearly $42 billion, while the estimated impact of home health spending on output exceeded $89 billion. Those figures were about $36 billion and $58 billion, respectively, in 2014.
Market overview steady
The percentage of Medicare beneficiaries who go to home health following a hospital discharge has held steady around 13% to 14% since 2012, the chartbook shows.
There has been a decline in Part A home health episodes, which fell from 2.41 million in 2015 to 2.19 million in 2017. However, Part B episodes increased in that timeframe, from 4.29 million to 4.43 million.
The backdrop of these trends is that hospital inpatient stays have been on the decline overall, as changes to the U.S. health system have incentivized more care in lower-cost settings, noted Jennifer Schiller, the Alliance’s director of policy communications and research.
“People still do see home health as a post-acute and not holistic benefit,” she told Home Health Care News. “Utilization trends may change over time as home health is looked at less as just a post-acute destination and as something that can benefit patients holistically, and lead to hospital avoidance.”
This is a paradigm shift that could be underway, according to industry leaders who spoke at the recent Home Health Care News Summit in Chicago.
The chartbook also includes demographic data on home health users, showing that it’s become more common for them to have three or more chronic conditions and two or more limitations with activities of daily living. An increasing number are dually eligible for Medicare and Medicaid, and compared with all Medicare beneficiaries, a greater proportion of home health users have severe mental illness.
“It provides a picture of who patients are,” Schiller said. “We know they’re older, sicker, poorer and more racially diverse than the rest of the Medicare population. [This report] paints a picture of who those patients are, their vulnerability and the need to address those patients through a benefit that’s extremely important to them.”
Written by Tim Mullaney