Heterogeneity in Medicare Home Health Patients by Admission Source

Fout, Betty; Plotzke, Michael; Jung, Olivia

doi:10.1177/1084822318793882

Cited by 5 publications

(8 citation statements)

References 8 publications

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“…Current HH reimbursement structures incentivize HH agencies to limit the number of visits provided; as a result, HH staff report difficulty addressing underlying social needs due to agency policies limiting visit frequency and duration 33 . Study findings echo previous research in demonstrating that community‐referred HH patients are more likely to have cognitive impairment and/or be at risk for incident ADRD diagnosis 14,34 . This highlights the need for revisions to the current Medicare HH payment system, which reimburses post‐acute episodes at a higher level than community‐entry episodes, to create reimbursement parity between referral sources for those with cognitive impairment, thus supporting continued access and quality of care 18,19,35 …”

Section: Discussionsupporting

confidence: 48%

Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode

Burgdorf¹,

Mroz

Reckrey

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONHome health (HH) may be an important source of care for those with early‐stage/undiagnosed Alzheimer's Disease and Related Dementias (ADRD), but little is known regarding prevalence or predictors of incident ADRD diagnosis following HH.METHODSUsing 2010–2012 linked Master Beneficiary Summary File (MBSF) and HH assessment data for 40,596 Medicare HH patients, we model incident ADRD diagnosis within 1 year of HH via multivariable logistic regression.RESULTSAmong HH patients without diagnosed ADRD, 10% received an incident diagnosis within 1 year. In adjusted models, patients were three times more likely to receive an incident ADRD diagnosis if they had HH clinician‐reported impaired overall cognition (compared to patients without reported impairment) and twice as likely if they were community‐referred (compared to hospital‐referred patients).DISCUSSIONThere is a pressing need to develop tailored HH clinical pathways and protect access to community‐referred HH to support community‐living older adults with early‐stage/undiagnosed ADRD.

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Section: Discussionsupporting

confidence: 48%

Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode

Burgdorf¹,

Mroz

Reckrey

et al. 2023

Alzheimer's & Dementia

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“…Mroz et al ( 14 ) found that community-admitted patients were significantly more likely to be nonwhite, Medicaid-enrolled, and have cognitive impairment; however, the sample was restricted to residents of rural areas. Fout et al ( 15 ) found that a greater proportion of community-admitted patients had cognitive impairment and were Medicaid-enrolled, and Wysocki and Cheh ( 6 ) found that community-admitted patients were significantly more likely to be Medicaid-enrolled and live in a state with high levels of home health provider fraud/abuse. However, none of these studies examined contextual factors measured before the home health episode or examined differences in patient characteristics by both referral source and number of episodes.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Our study fills two remaining gaps in the available literature regarding variation in home health patient characteristics between those with versus without an immediately preceding hospitalization. First, although contextual factors, such as availability of family caregivers, may affect home health care utilization and represent another facet of social vulnerability, all previous work has been restricted to measures gathered during the home health episode, missing potentially valuable information about patients’ social contexts ( 6 , 14 , 15 ). We draw on a unique analytic data set that links a nationally representative survey with comprehensive information on individual health, functional disability, and caregiver support before home health, to patient assessments conducted by home health clinicians during the episode of care and Medicare claims.…”

Section: Background and Objectivesmentioning

confidence: 99%

“…Second, the recent reduction in reimbursement affects two groups of patients, as described above: those initially referred from the community and those receiving multiple successive episodes. Prior research found that those initially admitted from the community were also more likely to receive multiple episodes of care ( 6 , 15 ). However, no previous work has separately examined these two pathways into home health to untangle whether observed variation in patient characteristics is driven by differences based on referral source, number of episodes, or both.…”

Section: Background and Objectivesmentioning

confidence: 99%

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Social Vulnerability and Medical Complexity Among Medicare Beneficiaries Receiving Home Health Without Prior Hospitalization

Burgdorf

Mroz

Wolff

2020

Innovation in Aging

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Background and Objectives Recent Medicare home health payment changes reduce reimbursement for care provided to patients without a preceding hospitalization. Beneficiaries may enter home health without a preceding hospitalization via referral from a community provider or through incurring multiple episodes of home health care. We assess potential implications of this change by examining characteristics of patients accessing Medicare home health through each of these pathways. Research Design and Methods Nationally-representative retrospective cohort study of 1,224 (weighted n=5,913,080) older adults who participated in the National Health and Aging Trends Study (NHATS) between 2011-2015, and received Medicare-funded home health within one year of interview. Patient characteristics before home health were drawn from NHATS while characteristics during home health, referral source, and number of episodes incurred were drawn from linked Outcomes and Assessment Information Set (OASIS) and Medicare claims. We tested for differences in characteristics by referral source and number of episodes using weighted chi-squared tests and t-tests. Results Patients referred to home health from the community were more than twice as likely to be Medicaid-enrolled (24.0% vs 12.5%, p<0.001), have dementia (29.5% vs 12.4%, p<0.001), and have received 80+ hours/month of family caregiver assistance (20.7% vs 10.1%, p<0.001) prior to home health entry compared to those referred from a hospital or skilled nursing facility. Patients who incurred multiple episodes in a spell of home health care were more likely to have high clinical severity during home health (48.3% vs 28.1%, p<0.001), compared to those with a single episode. Discussion and Implications Greater social vulnerability and care needs before home health were associated with community referral, while greater clinical severity during home health was associated with incurring multiple episodes of care. Findings suggest that recent payment changes may threaten home health access among beneficiaries with greater social vulnerability and/or medical complexity.

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“…Given emerging research demonstrating that a growing number of family caregivers are assisting with medically oriented tasks, 16,22 we also include clinician reports of the presence of pressure ulcers or wounds from the OASIS. Finally, in response to growing awareness of differences in characteristics of patients referred to home health from the community versus those referred following an inpatient stay, 23,24 we incorporate a measure of whether the home health episode is postacute. If the home health episode occurs within 14 days of inpatient acute or postacute care, we define this as a postacute episode.…”

Section: Methodsmentioning

confidence: 99%

Older Adult Factors Associated With Identified Need for Family Caregiver Assistance During Home Health Care

Burgdorf

Arbaje²,

Wolff

2019

Home Health Care Management & Practice

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Family caregivers make important contributions to home health care for older adults, but knowledge of the specific roles they assume is lacking. We analyzed data from 1,758 community-dwelling Medicare beneficiaries aged 65+ receiving Medicare-funded home health care between 2011 and 2016, using linked National Health and Aging Trends Study and Outcomes and Assessment Information Set data. Most (86.7%) beneficiaries receiving home health care had an identified need for family caregiver assistance, and nearly 6 in 10 (57.9%) had identified need for caregiver assistance with five or more tasks. After examining significant associations between older adult characteristics and identified needs for caregiver assistance with specific tasks, we identified three profiles of older adults who demonstrate similar patterns of identified need for family caregiver assistance during home health. These profiles include: (1) older adults with greater functional impairment who more often had identified need for assistance with Instrumental Activities of Daily Living, advocacy, or Activities of Daily Living; (2) older adults with cognitive impairment who more often had identified need for assistance with medication administration or supervision; and (3) older adults with greater clinical severity who more often had identified need for assistance with medical procedures and equipment. Findings support calls to develop training interventions and strengthen the partnership between home health providers and family caregivers. These three profiles present a potential framework for the development of family caregiver training programs.

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Heterogeneity in Medicare Home Health Patients by Admission Source

Cited by 5 publications

References 8 publications

Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode

Prevalence and predictors of incident ADRD diagnosis following a Medicare home health episode

Social Vulnerability and Medical Complexity Among Medicare Beneficiaries Receiving Home Health Without Prior Hospitalization

Older Adult Factors Associated With Identified Need for Family Caregiver Assistance During Home Health Care

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