Incomplete Home Health Care Referral After Hospitalization Among Medicare Beneficiaries

Abstract

Objectives: Patients who are referred to home health care after an acute care hospitalization may not receive home health care, resulting in incomplete home health referrals. This study examines the prevalence of incomplete referrals to home health, defined as not receiving home health care within 7 days after an initial hospital discharge, and investigates the relationship between home health referral completion and patient outcomes. Design: Retrospective cohort study. Setting and Participants: Medicare beneficiaries who are discharged from short-term acute care hospitals between October 2015 and December 2016 with a discharge status code on the hospital claim indicating home health care. Methods: Patient characteristics and outcomes were compared between Medicare beneficiaries with complete and incomplete home health referrals after hospital discharge. The outcomes included mortality, readmission rate, and total spending over a 1-year episode following hospitalization. These outcomes were risk-adjusted using patient demographic, socioeconomic, clinical characteristic, hospital characteristic, and state fixed effects.Results: Approximately 29% of the 724,700 hospitalizations in the analytic dataset had incomplete home health referrals after discharge. The rate of incomplete home health referrals varied among clinical conditions, ranging from 17% among joint/musculoskeletal patients and 38% among digestive/endocrine patients. Risk-adjusted 1-year mortality and readmission rates were 1.4 and 2.4 percentage points lower and total spending was $1053 higher among patients with complete home health referrals as compared with those with incomplete home health referrals after hospital discharge. Conclusions and Implications: The analysis revealed that almost 1 in 3 patients discharged from a hospital with a discharge status of home health does not receive home health care. In addition, complete home health referrals are associated with lower mortality and readmission rates and higher spending. As home health care utilization increases, policymakers should pay attention to the tradeoff between quality and cost when implementing alternative policies and payment models.

Analysis of Functional Recovery in Older Adults Discharged to Skilled Nursing Facilities and Then Home

“…Previous work has focused on factors associated with hospitalization or death in the SNF setting, and few studies have specifically examined outcomes among individuals discharged back into the community. In those studies, receiving HHC services after an SNF was associated with better clinical outcomes, 28 including lower odds of rehospitalization, SNF readmission, and death. 11 , 29 Furthermore, better SNF quality was associated with increased likelihood of HHC referral.…”

“…Importantly, postacute transitions are often complicated with errors associated with preventable readmissions 37 and planning that is often limited to short-term medical treatments or plans. 38 Understanding the expected length of recovery is critical for care coordination and long-term planning for patients and families, 5 , 28 , 39 who may not expect the intensity and duration of support a recovering older adult requires.…”

Mobile Integrated Health Interventions for Older Adults: A Systematic Review

“…Adults over the age of 75 are estimated to have 60 visits per 100 persons compared to all other age groups over 1-year-old ( Cairns, 2021 ). The persistent generalized risk for adverse health outcomes following a hospitalization, known as posthospital syndrome ( Krumholz, 2013 ) as well as fragmentation of follow-up care ( DeVore et al, 2016 ) and home services postdischarge ( Demiralp et al, 2021 ) create cycles of rehospitalization that can be difficult to disrupt.…”

Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients

“…In prior studies, approximately one-third of patients did not receive services following a referral. 10,11 Second, the discharge readiness assessment protocol was new to the nurses; it is possible that the findings would be different after nurses gain experience using the RHDS routinely in practice. Third, while the READI study protocol included instructions to the discharging nurse to use the assessment in planning discharge care, no information was collected on communication and use within the multidisciplinary team process.…”

“…For example, referral rates at hospital discharge were lower for Hispanic and American Indian patients than White patients in an analysis of a national sample of Medicare claims from 2014 to 2016 for discharges after diabetes-related index hospitalizations 9 . Racial and ethnic minority patients were less likely to actually receive services than White patients 9–11 ; Black and Hispanic patients were also found to have higher odds of rehospitalization during their HHC episode 12 and within 30 days post discharge 13 …”