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New Home Health Chartbook Shows Readmission Rates for Medicare Home Health Users Continue to Decline

October 22, 2015
Contact: Emily Adler

New Home Health Chartbook Shows Readmission Rates for Medicare Home Health Users Continue to Decline

Data show home health patients remain older, poorer, and sicker than the general Medicare population

The Alliance for Home Health Quality and Innovation (the Alliance) – a national non-profit consortium of home health care providers and organizations focused on research and education about home health care, and its ability to deliver quality, cost-effective, patient-centered care across the care continuum – recently released an updated Home Health Chartbook compiled by Avalere Health LLC. The Chartbook summarizes and analyzes statistics on home health economic and demographic trends from a range of government sources. 

The newest data shows a continued, steady decline in rehospitalization rates for home health users within 30 days of discharge for the top 20 most common diagnosis groups. The home health hospital readmission rate for Medicare patients decreased by nearly two percentage points, from 19.17 percent in 2011 to 17.39 percent in 2012. Data show the trend continuing, falling to 16.92 percent in 2013. Notably in 2013, the readmission rate for patients receiving home health as the first setting of post-acute care after a hospitalization for major joint replacement or reattachment of lower extremity (MS-DRG 470) was only 3.59 percent.

Major joint replacement surgery and the post-acute care following it has become a major health system focus as the Centers for Medicare & Medicaid Services (CMS) recently proposed the Comprehensive Care for Joint Replacement (CCJR) model, which seeks to bundle payment and quality measurement for episodes of care related to hip and knee replacements (for the inpatient hospitalization and the 90 days of post-acute care following it). The positive trends in reduced hospital readmission rates in post-acute care reflect provider efforts to improve care coordination and patient outcomes.

This year, the Alliance released a new supplement to the Chartbook that shows patient destinations after a hospital stay by state. The data in the supplement reflects wide geographic variation in the settings for post-acute care at the state level. For example, in Connecticut more than half of Medicare patients discharged from a hospital stay received formal post-acute care, with 18 percent of those patients being discharged to home health care. By contrast, in Oregon less than 40 percent of patients received formal post-acute care, and only 8 percent receiving post-acute care had home health covered by Medicare, despite having a similar population size to Connecticut.

“It’s important to note how different states are caring for Medicare beneficiaries in post-acute care settings,” stated Teresa Lee, Executive Director of the Alliance. “The Alliance has long been interested in issues relating to appropriate placement of patients in post-acute care and in 2012 released the Clinically Appropriate and Cost-Effective Placement (CACEP) project, which had been commissioned from Dobson DaVanzo and Associates. In that study, the researchers found that through clinically appropriate and cost effective placement in post-acute care, there is great opportunity for reducing Medicare spending.”

The most recent data show that home health patients continue to be older, sicker, poorer and disproportionately female compared with the general Medicare population. Home health beneficiaries are twice as likely to be over the age of 85, and 85 percent of home health beneficiaries live with three or more chronic conditions compared to just 62 percent of the general Medicare population. Sixty-seven percent of home health users have incomes at or under 200 percent of the Federal Poverty Level compared to just 52 percent of the overall Medicare population.

Additionally, the Chartbook revealed that the national averages for home health care quality measures improved or remained the same in more than 20 distinct areas of care.

The Alliance is hosting a webinar today, October 22, at 1:00 PM ET with Avalere Health that will provide an overview on the information in, and updates to, the Home Health Chartbook. Click here to join the webinar. The full 2015 Home Health Chartbook and supplement on post-discharge destinations by state is available on the Alliance's website.