Home Health Agency Performance in the United States: 2011–15

Abstract

OBJECTIVES To evaluate home health agency quality performance. DESIGN Observational study. SETTING Home health agencies PARTICIPANTS All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. MEASUREMENTS Twenty-two quality indicators, five patient survey indicators, and their composite scores. RESULTS The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011–12 to 2014–15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. CONCLUSION Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care.

Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016

“…People in regions that have high availability of nursing home care may not receive high-quality care, suggesting that the competition does not drive improvement. This observation is aligned with our previous study on home health care [28].…”

Heterogeneity in Medicare Home Health Patients by Admission Source

“…Patients with a community admission source tended to be female, black, Hispanic, dually eligible for Medicare and Medicaid, and have higher average Hierarchical Condition Category (HCC) risk scores compared with hospital and post-acute facility-based admission sources. 13 Community-admitted patients were substantially more likely to have more than one episode (84.6%) compared with hospital admitted (47.2%) and post-acute facility-based admitted (54.1%) patients. Community-admitted patients also had longer episode lengths (49.7 days on average compared with 37.7 for hospital-admitted patients).…”

Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Home Health Care

“…3 The availability of agencies has increased over the past 15 years, and Medicare spending on home health has increased from 8.5 billion in 2000 to 18.1 billion in 2015. 2,4 Quality of care varies across agencies, 5 which can impact patients’ post-discharge outcomes. Subsequently, home health agencies, along with the other post-acute settings, are the focus of ongoing healthcare reforms.…”