Study Shows Home Health Value in CJR Demonstration

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Amy Shellhart By Amy Shellhart 
Director of Product Management, Change Healthcare
CJR Demo Shows Value of Home Health

New research demonstrates the value of home health to provide quality care at a lower cost than many alternative care settings for patients undergoing lower extremity joint replacement (LEJR). Home health organizations in the 67 geographic areas where the Medicare Comprehensive Care for Joint Replacement (CJR) payment model began April 1, 2016, should pay close attention.

The Alliance for Home Health Quality and Innovation commissioned a study of the Medicare beneficiaries for MS-DRG 470 (major joint replacement without major complication or comorbidity) for 2011-2014. The analysis was completed using both the 5% and 100% samples of Medicare beneficiaries contained within the Standard Analytic Files Limited Data Set.

Analysis from Dobson | DaVanzo & Associates showed that home health use after a hospital stay “is associated with cost effective care and lower readmission rates for Medicare patients who have undergone major joint replacement surgery,” according to a news release. The analysis compared home health care to skilled nursing facilities (SNF), in-patient rehabilitation (IRF) and community care settings, which includes physician and outpatient therapy services.

This provides new ammunition for home health organizations in areas covered in the CJR payment model that want to partner with hospitals to care for CJR patients post-discharge.

The study shows wide disparity among geographies where patients are referred post-discharge that can’t be accounted for by level of acuity alone. Referrals to home health ranged from 5% to 75%, depending on geography.

Home Health Most Prevalent PAC Referral

Looking closer into the data, home health was the most prevalent post-acute care (PAC) setting in just over one-half of geographies (36 of 67 total areas). SNFs were most prevalent in one-third of areas, with community care the first referral in the remaining 10%. IRFs were not the most prevalent referral in any area.

Across all geographies, however, home health was used first in four out of every 10 discharges, compared with SNFs (36%) and IRFs (9%). Geographic disparity for any PAC referral—regardless of setting—varied widely. Among home health referrals, 75% of patients in the Gainesville, GA, metropolitan statistical area (MSA) were first referred to home health, while just 5% of patients in the Topeka, KS, MSA were referred.

Readmission rates also favored home health, with 8% of all episodes requiring a readmission related to the LEJR. SNF readmission rates averaged 12%, and IRF readmission rates averaged 15%. The location of first referral and readmission rates are likely influenced by a higher rate of fracture among patients referred to SNFs and IRFs. However, earlier research “suggests that regardless of differences in fracture rates, there may be considerable overlap in the clinical characteristics of patients who are admitted to HHAs, SNFs, and IRFs.”

Quality Care for Less

The average total Medicare episode payment is about $24,900 across all 67 areas regardless of where the post-acute care was delivered. Here are the averages and highs/lows for specific care settings:

  • Home health – $19,900 average; $17,400 low (San Francisco-Oakland-Hayward, CA); $21,400 high (Topeka, KS)
  • Skilled nursing – $31,500 average; $26,500 low (Buffalo-Cheektowaga-Niagara Falls, NY); $40,100 high (Beaumont-Port Arthur, TX)
  • In-patient rehab – $38,000 average; $32,200 low (Bismarck, ND); $45,600 high (Tuscaloosa, AL)

Taken as a whole, this study helps show the value of home health to quality outcomes and lower readmissions at a reduced cost. What can’t be quantified is the improved patient quality of life from receiving care at home instead of an institution.

Some patients, of course, will require a higher acuity of care following hospital discharge. But the wide range of home health referrals based on geography shows that home care organizations in the CJR demonstration areas should be educating their health systems on the value they bring to patients.

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