Alternative Measures of Resource Consumption in Home Care Episodes

Abstract

Expected changes in home health care reimbursement will require a shift in focus from a visit-based unit to some other yet-to-be-defined unit of resource consumption. Little research has been done to understand other measures of resource consumption, however, especially those examining disciplinary differences. The purpose of this study was to provide empirical evidence on other measures of resource consumption as a way to frame discussions on alternative measures. Information is presented from a study of 102 home health care patients from 10 agencies in Ohio who completed an episode of care and remained at home. While the mean time per visit was similar for all disciplines (46 to 55 minutes), there were differences in the number of visits provided by various disciplines (home care aide services had the highest mean number of visits with 11.8). The mean cost per day for all services was $43.80 while the mean cost per episode was $1,160. Recommendations for further research include similar examinations using a more rigorous sampling methodology and including disparate populations of patients.

The nature of safety problems among Canadian homecare clients: evidence from the RAI-HC©reporting system

“…The findings in this study are consistent with the results of some of the previous research. For example, the study by Madigan and Fortinsky (1999) identified unexpected deaths, falls, accidents and wound deterioration as the most frequent adverse events in their sample of US HC clients. The study of Winnipeg HC clients identified injurious falls, medication‐related events, pressure ulcers and mental harm as the most frequent adverse events (Johnson 2006).…”

“…2002). The results indicated that 13% of all HC clients had experienced an adverse event (Madigan & Fortinsky 1999, Madigan 2007). Clients who experienced such events were generally older.…”

Patient Problems, Advanced Practice Nurse (APN) Interventions, Time and Contacts Among Five Patient Groups

“…In some instances in which reimbursement for services is essential to agency survival, data can be skewed to services that receive greatest reimbursement. Number of provider contacts and time are essential components of current and evolving health care reimbursement policies (American Medical Association, 2000;Goldfield, 2000;Madigan & Fortinsky, 1999) Surveillance was consistently the predominant APN function across the five different patient groups, and health teaching, guidance, and counseling was the next most frequent APN function in four of the five groups. In all five groups, treatments APN functions and outcomes and procedures accounted for less than 1% of total APN interventions.…”

Predictors of functional capacity changes in a US population of Medicare home health care (HHC) patients with heart failure (HF)

“…Nursing visits were received by almost all patients (>99%), limiting the usefulness of examining the influence of nursing only services. Weekly visit intensity was calculated by dividing the total number of visits by the length of stay (Madigan & Fortinsky, 1999) and multiplying by seven. A visit intensity rate was used to control for similar numbers of visits being provided over varying lengths of stay.…”