Interactions Between Physicians and Skilled Home Health Care Agencies in the Certification of Medicare Beneficiaries' Plans of Care: Results of a Nationally Representative Survey

Boyd, Cynthia M.; Leff, Bruce; Bellantoni, Julia; Rana, Navpreet; Wolff, Jennifer L.; Roth, David L.; Carl, K.J.; Sheehan, Orla C.

doi:10.7326/m17-2219

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…Policy solutions have traditionally been directed at rationalizing payment across populations, geography, setting, and time (27–29). Our study contributes to an emerging body of evidence emphasizing the need to better coordinate health care and community-based long-term services and supports (30, 31) and the potential cost savings of assessing and addressing the care needs of high-risk sub-populations (32–35).…”

Section: Discussionmentioning

confidence: 92%

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability

et al. 2019

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Background: Identifying factors that affect variation in health care spending among older adults with disabilities may reveal opportunities to better address their care needs while offsetting excess spending. Objective: To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household, mobility, or self-care activities. Design: Observational study of in-person interviews and linked Medicare claims. Setting: United States, 2015. Participants: 3716 community-living older adults who participated in the 2015 National Health and Aging Trends Study and survived 12 months. Measurements: Total Medicare spending by spending quartile in multivariable regression models that adjust for individual characteristics. Results: Negative consequences were experienced by 18.3% of older adults with household disability, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences with household ($4,866 vs. $4,095), mobility ($7,266 vs. $4,115) and self-care disability ($10,935 vs. $4,436) versus those who did not. In regression-adjusted analyses, differences in median spending did not vary appreciably for older adults who experienced negative consequences in household activities ($338: 95% CI: $−768-$1,444) but was greater for those with mobility ($2,309: 95% CI: $208-$4,409) and self-care disability ($3,187: 95% CI: $432-$5,942). At the bottom spending quartile, differences were observed for self-care only ($1,460: 95% CI: $358-$2,561). No differences were observed at the top spending quartile. Limitations: This observational study cannot establish causality. Conclusion: Inadequate support with mobility and self-care activities is associated with higher Medicare spending, especially at the middle and lower end of spending, which creates the possibility that better supporting the care needs of older adults could offset some Medicare spending.

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Section: Discussionmentioning

confidence: 92%

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability

et al. 2019

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“…In a recent study of generalist physicians commonly engaged with skilled home health recipients, 78% reported rarely or never interacting with skilled home health clinicians. 6 While skilled home health offers important clinical services otherwise difficult to access by mobility-impaired people, no study to date has convincingly demonstrated the benefit of skilled home health. A recent study indicated that posthospitalization increases in continuity of care with primary care providers was associated with significantly fewer hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…Physicians and other providers vary in their involvement in coordinating care of the patient with skilled home health services. 6 In HBMC, health care providers (e.g. physicians, nurse practitioners, or physician assistants) and interdisciplinary care teams provide longitudinal primary or palliative care to individuals at home.…”

Section: Introductionmentioning

confidence: 99%

What’s Happening at Home

et al. 2019

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Background: Home clinical care (HCC) includes home-based medical care (HBMC-medical visits in the home) and skilled home health care (skilled nursing or therapy visits). Over seven million older adults would benefit from HCC; however, we know surprisingly little about homebound older adults and HCC. Objective: To describe HCC received by older adults using claims data within the OptumLabs® Data Warehouse.

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“…Better information communication will improve patient care by reducing missed clinical opportunities and providing research data for hospitalization risk predictive analytics. Studies highlight shortcomings in patient information communication along transitions in care [ 1 ], especially to home health care and between home health care and physicians [ 2 , 3 ], which are impediments to care coordination [ 1 ]. This inadequacy occurs in the United States [ 4 ] (US) and abroad [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A solution is electronic transmission of patient information [ 1 , 3 , 13 ] between electronic health record systems, and to embed home health care information into the routine outpatient clinical workflow for information to be more timely and accurate [ 1 , 3 ]. This communication necessitates implementation of reference terminologies (data standards) along the care transition.…”

Section: Introductionmentioning

confidence: 99%

Addressing the Gap in Data Communication from Home Health Care to Primary Care during Care Transitions: Completeness of an Interoperability Data Standard

2022

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In a future where home health care is no longer an information silo, patient information will be communicated along transitions in care to improve care. Evidence-based practice in the United States supports home health care patients to see their primary care team within the first two weeks of hospital discharge to reduce rehospitalization risk. We sought to identify a parsimonious set of home health care data to be communicated to primary care for the post-hospitalization visit. Anticipating electronic dataset communication, we investigated the completeness of the international reference terminology, Logical Observation Identifiers Names and Codes (LOINC), for coverage of the data to be communicated. We conducted deductive qualitative analysis in three steps: (1) identify home health care data available for the visit by mapping home health care to the information needed for the visit; (2) reduce the resulting home health care data set to a parsimonious set clinicians wanted for the post-hospitalization visit by eliciting primary care clinician input; and (3) map the parsimonious dataset to LOINC and assess LOINC completeness. Our study reduced the number of standardized home health care assessment questions by 40% to a parsimonious set of 33 concepts that primary care team physicians wanted for the post-hospitalization visit. Findings indicate all home health care concepts in the parsimonious dataset mapped to the information needed for the post-hospitalization visit, and 84% of the home health care concepts mapped to a LOINC term. The results indicate data flow of parsimonious home health care dataset to primary care for the post-hospitalization visit is possible using existing LOINC codes, and would require adding some codes to LOINC for communication of a complete parsimonious data set.

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Interactions Between Physicians and Skilled Home Health Care Agencies in the Certification of Medicare Beneficiaries' Plans of Care: Results of a Nationally Representative Survey

Abstract: National Institute on Aging and National Institute of Mental Health.

Cited by 9 publications

References 16 publications

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability

What’s Happening at Home

Addressing the Gap in Data Communication from Home Health Care to Primary Care during Care Transitions: Completeness of an Interoperability Data Standard

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