Medicare-certified home health agencies are increasingly facing ownership changes, raising concerns about health care spending, workforce and quality of care.

The study by researchers at the University of Texas Health in Houston examined whether a change in ownership was associated with different quality-of-care outcomes, patient volume and staffing levels.

“Ownership changes in health care sectors – including various forms of acquisitions by health systems, insurers, private equity firms and other corporate investors – is increasingly reshaping U.S. health care systems and causing concerns about the quality of care,” Yucheng Hou, assistant professor in the Department of Management, Policy and Community Health at UTHealth Houston School of Public Health said in a statement to Home Health Care News. “Some types of ownership changes, such as private equity firms’ acquisition of health care organizations, could shift focus to short-term profit generating instead of providing high-quality care.”

While other studies have examined the implications of ownership changes in hospitals, physician practices and nursing homes, Hou said this is one of the first to investigate home health agencies.

Hou’s team examined 294 Medicare-certified home health agencies through change-of-ownership files linked to publicly available Medicare data from 2016 to 2019. They were compared to 2,330 matched controls before and after the transaction.

In the three years after ownership changes, quarterly star ratings increased by 0.18, with more significant increases seen among home health agencies that converted from nonprofit or government-owned to for-profit. Per-capita Medicare payments also increased within two years of the ownership change. However, the study found that 60-day hospital admission rates and emergency department visits remained the same.

“Although we find an increase in the home health star rating, this measure is mostly composed of self-reported quality measures from the agencies, so there may be room for upcoding,” Hou said.

According to Hou, the most concerning finding was the reduction in staffing levels, down 17% for nurses and 26% for home health aides. There was also a reduction in per-visit minutes for patients, down 5% for skilled nursing, 3% for physical therapy and 11% for home health aide care.

“Overall, our results are consistent with the growing evidence of corporate consolidation in other health care sectors, which paints concerning implications of ownership changes on the quality of care,” Hou said.