Readmission Rates Higher Among Dual-Eligibles

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Billie Whitehurst By Billie Whitehurst, MS, RN 
Executive Vice President, Extended Care and Care Operations, Change Healthcare
Home Care Patient in Hospital

A new study underscores a link between demographic and income disparities and hospital readmissions, important findings for the home care industry as it moves toward value-based purchasing.

“Association Between Race, Neighborhood, and Medicaid Enrollment and Outcomes in Medicare Home Health Care” was published in the Journal of the American Geriatrics Society in October. A look at fee-for-service Medicare beneficiaries between 2012-2014, the study included 30- and 60-day clinical outcomes, including readmissions, an important metric for hospitals.

The study concluded that “Medicare beneficiaries receiving home health services who are dually enrolled, live in a low-income neighborhood, or are black have higher rates of adverse clinical outcomes. These populations may be an important target for quality improvement under Home Health Value-Based Purchasing.”

Rural versus other geographies

Implications are numerous for dual-eligible patients and the home health organizations that work with them to regain mobility and age in place.

If you’re working with a health system on a readmission reduction program, you’ll want to share these study findings with the appropriate executive or program manager. It’s critical that all participants in a shared-savings or shared-risk scenario understand the role that dual-eligibility, demographic and income factors can play in readmissions. You’ll also want to share information from the following study that examined geographic factors in readmits.

A study published in 2016 in the Journal of Rural Health examined the readmission rates among dual-eligibles, comparing rural patients with those in suburban or urban settings. The study focused on dual-eligible hospitalizations during 2009. The study indicated that overall readmissions were higher among dual-eligibles as a percentage. Dual-eligibles comprise 19% of Medicare enrollees but accounted for 21.5% of the readmissions.

However, dual-eligible patients who live in rural settings experienced lower readmission rates than those living in other geographies. Other factors increasing the likelihood of a readmission include a younger age and specific chronic conditions.

Industry lessons

Home health organizations need to balance patient needs with those of the business. That’s why you should pay close attention to your payer mix and the gross margins for each line of business.

You may want to look closely at the percentage of dual-eligible patients in your census. The purpose isn’t to exclude these patients but to ensure they are receiving the types and quantities of care they need to avoid hospitalizations or rehospitalizations. Pay particular attention to the demographic factors the studies cited above and make sure your referral partners understand the potential implications of those factors, too.

Finally, if your organization is participating in the Home Health Value-Based Purchasing (HHVBP) program, be sure to highlight the unique census of your organization as it relates to the demographic factors cited in any required reports.

Each one of us is different, reacting to the exact same treatments or medications in wildly different ways. It makes perfect sense that demographic factors would affect outcomes, so make sure your referral partners and regulators are aware of any extenuating factors that could undermine the care your organization provides.

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