Home Health Saves $15,233 per Patient while Improving Survival

In April, The American Journal of Medicine published a study reviewing the files of 17,629 patients discharged from the Cleveland Clinic. Researchers set out to evaluate the effect of home health on healthcare resource utilization.¹ Their subjects included 6,363 patients discharged to home health and 11,266 matched controls who elected self-care at discharge.

During the 365 days following discharge, patients who received home health services spent $15,233 less on health care compared to the patients who elected self-care. This was in absolute dollars. After adjusting for covariates, researchers tallied the one-year savings associated with home health at $6,433. These savings accrued despite the fact that Medicare pays 100% for home health services with no copay or deductibles for patients.​

Savings were generated in part by reducing readmissions. Home health correlated with an 18% reduction in the rate of hospital readmissions. However, savings also occurred simply through improved overall health. Patients in the home health group had a 20% lower mortality rate.

Home health performed better with some disease types. The mortality rate reductions for digestive diseases was 28%. The readmission rate reduction for neurological diseases was 33%. The adjusted savings for heart disease were nearly double the average across all diseases ($11,453).

The authors note that this was the first report investigating the utility of home health among a large and diverse patient base. When referring to reports in peer-reviewed journals this is true. However, a larger industry study commissioned by CMS and the US Department of Health & Human Services had similar findings in 2016.² In that study, researchers accessed the Medicare billing records for every 2014 hospital discharge in New Jersey that received a home health referral – 36,964 cases. One-third did not receive home health. Home health correlated with a 30% reduction in 30-day rehospitalization rates. Previous studies finding that home health reduces readmissions focused on specific care paths: dyad interventions for stroke survivors,³ nutritional intervention,⁴ A1c management,⁵ home nursing following coronary artery bypass graft,⁶ etc. In general, when patients are homebound and have a skilled need, electing self-care may compromise medical outcomes and increase one-year spending compared to receiving home health. ​

Leaders in Preventing Hospitalization

Risk-adjusted Medicare data shows that Five Star leads both California and America in preventing unnecessary hospitalization during the home health episode. Compared to other home health agencies nationwide, the patients you refer to Five Star prove 28% less likely to need hospitalization. This one objective measure serves as a strong indicator for overall quality of care. When you want industry-leading care for your patients. . .

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References:

1. Xiao R, Miller J, Zafirau W, et al. Impact of home health care on health care resource utilization following hospital discharge: a cohort study. The American Journal of Medicine. 2018; 131 (4): 395-407.
2. Quality Insights. New Jersey Home Health Readmission Report. US Dept Health Human Services. 2016; Pub QI-C3-112015.
3. Bakas T, Clark P, Kelly-Hayes M, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke. 2014; 45 (9): 2836-2852.
4. Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clinical Nutrition. 2010; 29 (1): 47-53.
5. Centers for Medicare & Medicaid Services. Response to Comments for Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus. 2014; LCDs L35413 and L35132.
6. Hall M, Esposito R, Pekmezaris R, et al. Cardiac surgery nurse practitioner home visits prevent coronary artery bypass graft readmissions. Ann Thorac Surg. 2014; 97: 1488-95.