New Analysis Shows Role Home Health Plays in Reducing Readmissions

Last week the Alliance for Home Health Quality and Innovation released new data regarding the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Care for Joint Replacement (CJR) Model.

The data analysis, conducted by Dobson DaVanzo & Associates, comes just more than two months after CMS launched the bundled payment model for major joint replacements in 67 regions of the country.

The analysis looks at discharges between October 2011 and September 2014 for patients from the hospital to various post-acute care (PAC) settings who underwent major joint replacement without major complication or comorbidity. It found that by sending patients to home health as opposed to a facility based setting, hospitals can lower the cost of the episode payment by $5,000 and reduce the risk of patients returning to the hospital.

Across all (PAC) settings, eight percent of episodes contained a readmission, but that number drops to an average of five percent for patients who received home health after their hospital stay. This is compared to readmission rates of 12 to 15 percent for patients receiving rehabilitation in facility-based settings.

As hospitals across the country begin implementing the new CJR payment model, this new data demonstrates that home health is a key component to reducing overall costs and bettering patient outcomes.

Home Health Value Kit: The Human, Clinical and Fiscal Value of the Skilled Medicare Home Health Benefit

We are pleased to release a new Home Health Value Kit: a guide that provides comprehensive information on the value of the Medicare home health benefit. Home healthcare provides clinically advanced, cost effective post-acute and chronic care management in the setting patients desire most – their home. So it’s critical for lawmakers, their staff, and other stakeholders to understand the benefits it has for patients, taxpayers and the Medicare program. Continue reading for a quick look into the kit and the information it offers:

Overview

This kit contains thorough information regarding home healthcare, from details about what home health care is, who receives it, information about the Partnership, and an outline of the human, clinical and fiscal value of the Medicare home healthcare benefit. You can also learn more about how you can support and empower the senior population through Bring The Vote Home, a national initiative designed to collect seniors’ opinions on a wide range of issues while simultaneously empowering both seniors and disabled Americans to engage fully in America’s electoral process.

Quick Facts

Human Value of Home Health

Home health patients are older, poorer and sicker than the Medicare population as a whole:

  • 4% of home health Medicare beneficiaries are older than 85
  • 2% live with five or more chronic conditions
  • 2% live at or below 200% of the Federal Poverty level

Clinical Value of Home Health

Patients in high quality home health and home-based care programs experience:

  • 26% fewer acute care hospitalizations
  • 59% fewer hospital bed days
  • A total of 19-30% savings in medical costs

Fiscal Value of Home Health

Skilled home healthcare is widely recognized as cost effective:

  • Medicare saves an average of $5,411 if home healthcare is the first post-acute setting utilized after a patient receives major joint replacement.
  • The average cost of care in a skilled nursing facility is $449 per day or $26,940 for a 60-day stay compared to $2,674 for a 60-day home health episode.

Want to learn more?

To view the kit in its entirety, click here.

New Data Shows Decline in Hospital Readmissions for Home Health Patients

The Alliance for Home Health Quality and Innovation has worked with Avalere to release an updated Home Health Chartbook, providing a broad overview of home health patients, the home health workforce, organizational trends, and the economic contribution of home health agencies.

The updated analysis of America’s home health population and industry highlights a number of positive trends with regards to both quality and patient outcomes since the 2013 data was released.

The study revealed that in the past year patients got markedly better at walking or moving around and had less pain when doing so.  Patients also experienced improved breathing and were better able to both bathe and take drugs correctly.

In addition to elevated patient outcomes, home health teams met superior quality measures more frequently.  Indeed, a staggering 99% of providers met quality standards for checking patients for the risk of developing pressure bedsores.  Moreover, 98% achieved high standards for monitoring a patients’ risk of falling.

Across the board, Americans benefited from improvements to the delivery of high quality home health care.  Amazingly, home healthcare already allows millions of seniors to receive highly effective care in a patient’s preferred setting – their own home.  Now, it is only getting better.

We will continue to fight for Americans already reaping the benefits of home health, and ensure that there is only more good news to come.

Cleveland Clinic Journal of Medicine Focuses on Home Health

Last month, the Cleveland Clinic Journal of Medicine (CCJM) partnered with the Alliance for Home Health Quality and Innovation to release a supplement to the CCJM, which examined the critical role home health has in the nation’s healthcare delivery system. Leading medical experts and home health professionals presented outcomes from innovative approaches to home health and offered a variety of perspectives on topics such as:

• Transitional care
• Chronic disease management
• Palliative care
• Health care technology

At a Capitol Hill briefing, supplement authors discussed how home healthcare could be better utilized across healthcare systems to streamline care, improve patient outcomes and reduce healthcare costs. Key take-aways from the presentation include:

• Better management of the care transition process – such as moving the patient from the hospital to home health – can result in measureable outcomes including a decrease in the average readmission rate.
• Because Americans are living longer and want to remain in their homes, it is especially important that we find better ways to coordinate care at the time of discharge so that chronically ill older Americans can be cared for in a more clinically and cost-effective way.
• There is great evidence that supports the value of home health in providing supportive and recuperative care services in our nation’s health care system.
• As the prevalence of seniors requiring care for chronic and advanced illnesses grows, more integrated systems and increased coordination will be critical to ensuring quality of life for the Medicare population.

In addition to serving as a resource to policy makers and thought leaders, the supplement is a peer-reviewed monthly medical journal and continuing-education product, which offers practical and clinical information relevant to a variety of healthcare fields.

To access the full supplement, Optimizing Home Health Care: Enhanced Value, Improved Outcomes, visit here.

American Action Forum Primer on VA Home Based Primary Care

By Doug Holtz-Eakin, President, American Action Forum

Two recent studies suggest that home healthcare should be given a close look in reforming Medicare.  The American Action Forum recently released a paper by Emily Egan entitled, “VA Home Based Primary Care Program: A Primer and Lessons for Medicare.” The goal of the primer was to summarize the working of the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC), shed some light on its effectiveness, and draw any lessons for home health in the Medicare program.

HBPC began in 1972 (with 6 demos) and serves veterans with chronic and disabling conditions who need more care than periodic doctor visits.  It uses teams of medical directors, nurses, social workers, dietitians, psychologists, pharmacists and rehabilitative therapists to provide integrated and coordinated care for the patient.

The program appears to have been a success in that participants experienced a drop of 62 percent in hospital days, 88 percent in nursing home care days, and 24 percent in overall care costs. In addition, on study concluded that participants in the HBPC program had higher scores for “health related quality of life” than a comparable control group.

All of this suggests that Medicare ought to take a close look at HBPC.  However, Medicare as it is currently structured is not set up to simply copy the VA approach, as the home health benefit has different eligibility requirements and services. Medicare’s home health benefit is focused on the homebound; not the larger number of chronically ill patients.  Moreover, Medicare permits up to 60 days of care, while the HBPC has unlimited visits as long as they are medically appropriate. Finally, Medicare is more narrowly focused on health and rehabilitation as opposed to the coordination of a team in the HBPC.  In short, taking the HBPC approach would expand the population, number of visits, and services available – a major expansion for Medicare that would have to be offset by cost-savings obtained.

It should be noted, that there is some hope on this front as well.  A recent “Clinically Appropriate and Cost-Effective Placement” (CACEP) report from the Alliance for Home Health Quality and Innovation suggests that placing post-acute care patients in the most clinically appropriate setting can deliver large savings for the Medicare program by significantly reducing hospital admission and readmission rates.  In some cases, home healthcare is the most appropriate setting.

What’s the bottom line?  The combination of the two studies raises the tantalizing possibility that a HBPC-like approach to the Medicare home health benefit might provide more and better care, and at the same time lower the cost of Medicare.  It is a lofty goal, but with Medicare’s looming insolvency, policymakers need to consider major changes with the potential for major results.

Patient Perspective: Meet Georgia

Meet Georgia*, a Floridian in her late 80s with a history of heart and lung disease. Georgia was living on her own until she was hospitalized for lung complications, but medical and safety issues prevented her from returning to her independent lifestyle.

With the help of a skilled home healthcare program, Georgia was able to resume activities of daily life, receive assistance from programs like Meals on Wheels, and manage her medical conditions from home.

Click the arrow below to view the presentation: