While home health care is often touted as a cost-effective way to reduce readmissions, skilled nursing facilities (SNFs) — though more expensive — might be better at keeping patients out of the hospital post-discharge.
That’s according to a new article published in JAMA Internal Medicine, which shows readmission rates for patients discharged to home health agencies were 5.6 percentage points higher than those who went to SNFs.
Researchers analyzed more than 17 million hospitalizations of Medicare beneficiaries to reach the findings, which compare home health and SNF patients using readmission rates at 30 days post-discharge, mortality rates at 30 days post-discharge, improvement of functional status and Medicare payments.
Patients studied could have appropriately been discharged to either setting. However, the majority of patients (61.2%) were discharged to SNFs, while 38.8% of patients were discharged to home health care services.
While mortality rates and functional status were very similar when comparing home health and SNF patients, readmission rates and costs varied greatly.
“There’s a significant trade-off in the amount of money we spend on post-acute care and patient outcomes,” Rachel Werner, lead author and associate chief for research in the Division of General Internal Medicine at the University of Pennsylvania in Philadelphia, told Home Health Care News. “Medicare spent significantly less money on [patients discharged to home health agencies] than they did on patients who were discharged to a SNF, but they also had higher rates of readmission.”
Since 2012, hospitals have been held liable for avoidable readmissions for certain patients. Medicare financially penalizes hospitals for high readmissions in patients with pneumonia, heart failure and hip and knee replacement, along with chronic obstructive pulmonary disease (COPD) and other select conditions.
As such, there’s a growing push to reduce readmissions rates, which researchers found SNFs do a superior job of compared to home health agencies.
However, researchers hypothesized that readmission rates of home health patients were several percentage points higher than their SNF counterparts for multiple potential reasons.
For example, SNFs can monitor patients 24-hours per day and often provide “a higher level of treatment intensity,” the researchers wrote.
Additionally, the study only looks at Medicare beneficiaries who could appropriately be discharged to either a home health agency or a SNF.
SNF’s reduced readmission rates come at a cost — literally.
Medicare reimbursement for home health care was significantly lower than for SNF care, in turn saving the program more money.
Hospital patients discharged to a home health agency reduced the average Medicare spending on post-acute care by $5,384 and cut the overall 60-day episodic cost by $4,514, according to the study.
“Even after accounting for the lower costs from fewer readmissions from SNFs, the total amount paid by Medicare for hospitalizations and post-acute care during the 60-day post-hospital period is lower for patients discharged to home compared with those discharged to a SNF,” the researchers wrote.
These results warrant further investigation of post-acute care settings to improve costs and care, Werner believes.
“Patients often prefer a home-based setting rather than an institutional setting such as SNFs, so trying to balance the benefits, such as reduced readmissions, with patient preferences is a challenge,” Werner said. “I think the solution to that is to find better ways to balance the financial incentives to reward outcomes and quality of care in addition to reducing cost — [and] also to consider alternative ways to provide more intensive care at home.”