Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries with Rehabilitation-Sensitive Conditions

Publication date: Available online 21 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tracy M. Mroz, Ann Meadow, Elizabeth Colantuoni, Bruce Leff, Jennifer L. Wolff
ObjectiveTo examine associations between organizational characteristics of home health agencies (e.g., profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes among Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.Design, Setting, and ParticipantsRetrospective analysis of Medicare administrative data for 1,006,562 fee-for-service beneficiaries admitted to 9,250 Medicare-certified home health agencies in 2009.InterventionsNot applicable.Main Outcome MeasuresInstitutional admission during home health, community discharge, and institutional admission within 30 days of discharge.ResultsNonprofit (versus for-profit) home health agencies were more likely to discharge beneficiaries to the community (OR 1.23, 95%CI: 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR 0.93, 95%CI: 0.88-0.97). Agencies in rural (versus urban) counties were less likely to discharge patients to the community (OR 0.83 95%CI: 0.77-0.90) and more likely to have beneficiaries incur institutional admissions during home health (OR 1.24 95%CI: 1.18-1.30) and within 30 days of discharge (OR 1.15 95%CI: 1.10-1.22). Agencies with contract (versus in-house) therapy staff were less likely to discharge beneficiaries to the community (OR 0.79, 95%CI: 0.70-0.91) and more likely to have beneficiaries incur institutional admissions during home health (OR 1.09 95%CI: 1.03-1.15) and within 30 days of discharge (OR 1.17, 95%CI: 1.07-1.28).ConclusionsAs payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.



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