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Study Shows Home Care Keeps Patients Out Of Hospitals, Other Facilities

Published by Inside Health Policy
John Wilkerson
May 24, 2012

Home care companies this week released a study showing that when patients are discharged from the hospital to their homes, where they receive home care services, they tend to stay out of institutional facilities, which saves the health care system money. Those patients receive healthcare services longer than those who go directly into other facilities, such as nursing homes, but they receive that care in ambulatory settings, typically doctors' offices, which is cheaper than sending them to institutions, according to the analysis, by Dobson Davanzo & Associates, of Medicare claims for the Alliance for Home Health Quality & Innovation.

This is the third in a four-paper series by Dobson Davanzo, collectively called the Working Papers of the Clinically Appropriate and Cost-Effective Placement. The earlier papers detail the frequency of services provided across care settings for similar clinical conditions, and they provide comparative baseline statistics for three key areas Medicare considers in its reimbursement methodology.

This third paper describes “patient pathways” by episode type for certain MS-DRGs and primary chronic conditions. The paper defines patient Pathways and “the care process experienced by each individual patient across all care settings within an episode. Each pathway is made up of 'sequence stops,' which may include admission to a post-acute care setting or outpatient care by a physician.” Understanding these pathways shows how care is delivered across episodes, which can then be used to influence policy decisions and payment reforms.

Improved care transitions and chronic-condition management, including efforts led by home health providers, can help prevent hospital readmissions and avoid aggravating chronic conditions, the paper states. Two factors - hospital readmissions and the number of chronic conditions - largely contribute to the number of times patients receive care after hospital discharges.

Home care services also help keep patients with chronic illnesses out of the hospital in the first place, the report states. Home care providers care for patients with varying degrees of severity and multiple chronic conditions who do not go to the hospital. Ten of the most common “pathways” consist solely of home care and community care (doctor and outpatient visits). That suggests that home and community-based services may effectively help patients to prevent avoidable facility-based care, the report suggests.