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News Roundup: October 23, 2015

The Return Of The House Call?

Published by Healthcare Design
By Chris Bormann
October 23, 2015

My wife and I come from families of doctors and nurses spanning several generations. Her 95-year-old grandfather, a retired physician, recently regaled us of his first house call in 1945. As a young intern at Columbia’s College of Physicians and Surgeons, he was handed his “delivery pack” and sent out to deliver a baby in an apartment in Manhattan.

Clearly, this was a critical house call.

Today, my sister-in-law is a home health nurse for a regional health system, and every day she is responsible for coordinating the home care for six to eight patients, including the work of various other specialists such as physical, occupational, and speech therapists. All of this care is delivered in the patient’s home, which seems to me to be on the extreme opposite end of the acuity spectrum—or is it?

Is acute healthcare returning to the home? She spoke of the types of patients she cares for, their diseases and multiple medications, and the various lifestyle changes necessary for them to become healthier and more self-sufficient. She said that many of the same patients she sees in their homes were actually critical care inpatients a year earlier.

Inside the hospital, the clinical staff has complete control over the patient’s environment of care, including nutrition, hygiene, medication compliance, rest, therapies, visitation, and safety. All of these aspects of the patient’s hospitalization are geared towards optimizing clinical outcomes, yet few of these elements are available in the home. So how can a patient’s condition be expected to clinically improve better than they would—or at least as well as—if they were in a hospital?

The limited research conducted on home healthcare over the last five years has revealed that for certain types of care, there are actually few differences in patient outcomes between home health delivery and hospitalization.

A study of a Johns Hopkins home care program published by Cryer et al. in 2012 revealed an increase in positive outcomes for home healthcare patients and a slight decrease in readmission rates and mortality rates compared to hospitalized patients. The program used technology to remotely monitor and observe patients while in their home environment, with 24-hour staff availability, and recorded satisfaction ratings that were 10 percent higher than hospitalized patients and a reduced cost of care due to shorter lengths of stay.

Additionally, a study published by Shepperd et al. in 2009 found that home healthcare resulted in a 38 percent reduction in mortality compared to hospitalizations.

Even if research is limited and there are many variables resulting in multiple outcomes, initial studies do suggest that home health is comparing favorably, even better, than hospitalizations. So what does this mean from a hospital planning perspective?

It might suggest that accommodations should be made for remote organizational control of all of this decentralized care delivered by home health. Hospitals will need a cadre of specially trained clinical care coordinators to oversee the process—where will they work and will this take place virtually? Maybe patients will be provided an iPad to use for their physician assessment and hospitals will house a virtual care center where specialists will consult with one another and provide patient consults remotely—potentially from all over the world. This increased virtual access to specialists might also improve outcomes.

If this tactic stands to improve outcomes and finances, then home health will continue to expand and the network of on-foot-providers and virtual consults must be worked into the overall strategic master plan of each provider network.

We might also conclude that the growth of home health will ensure that only the highest acuity patients will be treated in hospitals. To create a complete continuum of care for population-based health, home care plays an increasingly important role. It would seem we are in fact returning to the house call—where medicine began.

Home Health Readmission Numbers Keep Getting Better

Published by Home Health Care News
By Kourtney Liepelt
October 23, 2015

Rehospitalization rates among Medicare patients from a home health setting are on the decline, and with an increased emphasis on coordination of care, the positive trend should continue, according to data recently updated by the Alliance for Home Health Quality and Innovation, a national non-profit consortium of home health care providers and organizations.

The Home Health Chartbook, compiled by Avalere Health LLC, summarizes and analyzes statistics on home health economic and demographic trends from various government sources. The latest data included in the Chartbook shows a steady decline in hospital readmission rates for home health users within 30 days of discharge for the top 20 most common diagnosis groups.

Specifically, the home health rehospitalization rate for Medicare patients decreased by nearly two percentage points, from 19.17% in 2011 to 17.39% in 2012. The data shows that trend is continuing, as the rate fell to 16.92% in 2013. Alliance Executive Director Teresa Lee attributes the decline to alternate models of health care delivery, such as the Accountable Care Organization program and bundled payments.

“The health care system has become much more attuned to the issue of readmission, and it’s starting to put in place programs that better support patients after they leave the hospital,” Lee tells Home Health Care News. “Home health is very much viewed as part of the solution.”

Supplemental data released by the Alliance depicts patient destinations after a hospital stay, and it suggests that post-acute settings widely vary at the state level.

More than half of Medicare patients discharged from a hospital stay in Connecticut received formal post-acute care, with 18% being in a home health setup. In Oregon, however, less than 40% of patients received formal post-acute care, with only 8% receiving such care at home, despite having a similar population as Connecticut.

The Chartbook also indicates that home health patients continue to be older, sicker and poorer than the general Medicare population. Home health users were twice as likely as typical Medicare beneficiaries to be over age 85, for example, and 85.1% had three or more chronic conditions. Further, 67.2% of home health users were at or under 200% of the Federal Poverty Level, versus 52.1% among the Medicare population as a whole.

“As the population ages, it’s a known and anticipated trend that we’re going to see patients with greater needs,” Lee tells HHCN. “It wouldn’t be surprising to see that into the future.”

The Chartbook unveiled a variety of other findings, including:

Gender: About 61.5% of home health users were female in 2013, as compared to 54.6% of all Medicare beneficiaries. Meanwhile, males accounted for 38.5% of home health users and 45.4% of Medicare beneficiaries overall.
Income and Race: Approximately 92.4% of Hispanic patients receiving in-home health care and 84.6% of black patients had an income under 200% the Federal Poverty Level in 2013, while 67.2% of all Medicare home health users had similar income levels.
Mental Illness: More than a quarter of home health users had a severe mental illness including bipolar disorder, schizophrenia and depression, whereas 18.7% of all Medicare beneficiaries had such illnesses.