Table 3. Unadjusted Utilization, Medicare Payments, OASIS-Based Quality, and Patient Experience Measures for Home Health Patients.
| Measure (unit of analyses) | HHVBP states | Non-HHVBP states | Baseline standardized difference in means | ||
|---|---|---|---|---|---|
| Baselinea | Interventiona | Baselinea | Interventiona | ||
| HH agency-years, No.b | 6906 | 9985 | 29 446 | 44 808 | NA |
| HH FFS patients, No.b | 2 525 841 | 4 014 649 | 7 898 642 | 12 570 221 | NA |
| HH FFS episodes, No.b,c | 4 422 930 | 7 704 805 | 15 417 548 | 26 353 991 | NA |
| OASIS episodes, No.b | 4 512 774 | 8 146 184 | 14 698 265 | 27 291 616 | NA |
| HH utilization (county-year level) | |||||
| Percentage of FFS beneficiaries with at least 1 HH episode, county-year level, % mean (SD) | 9.8 (416.1) | 9.1 (332.1) | 9.3 (262.2) | 8.9 (242.4) | 0.001 |
| Health care utilization during HH episodes (FFS episode level) | |||||
| Unplanned acute care hospitalizations among first HH episodes, % | 15.7 | 15.5 | 16.3 | 15.6 | –0.017 |
| Total ED use among first HH episodes, % | 26.6 | 27.6 | 27.6 | 27.6 | –0.022 |
| Outpatient ED use among first HH episodes, % | 11.7 | 12.5 | 12.3 | 12.6 | –0.017 |
| ED use followed by inpatient admission among first HH episodes, % | 14.2 | 14.5 | 14.2 | 14.1 | –0.002 |
| SNF use among all HH episodes, % | 4.9 | 4.4 | 4.0 | 3.7 | 0.040 |
| Average Medicare Parts A and B payments per day (FFS episode level) | |||||
| During and following FFS HH episodes of care, mean (SD), $d | 130.85 (1525.42) | 152.80 (1502.31) | 127.69 (1537.98) | 153.84 (1518.61) | 0.002 |
| Components of average Medicare payments per day during and following FFS HH episodes of cared (FFS episode level), mean (SD), $ | |||||
| HH | 38.44 (186.47) | 44.08 (163.57) | 36.38 (173.17) | 45.90 (166.61) | 0.011 |
| Inpatient | 43.93 (1189.95) | 53.82 (1271.72) | 45.97 (1239.92) | 55.50 (1322.81) | –0.002 |
| Outpatient institutional | 10.81 (237.28) | 14.24 (272.55) | 11.56 (241.17) | 15.35 (277.93) | –0.003 |
| ED and observation stays | 3.01 (88.48) | 3.98 (110.26) | 2.73 (79.94) | 3.59 (99.65) |
0.003 |
| Other | 7.71 (205.31) | 10.17 (236.50) | 8.75 (214.63) | 11.67 (247.69) | –0.005 |
| SNF | 12.15 (432.37) | 10.79 (365.33) | 11.13 (421.55) | 10.53 (384.83) | 0.002 |
| Hospice | 3.20 (178.63) | 4.32 (173.28) | 2.60 (150.02) | 3.76 (155.56) | 0.003 |
| Part B noninstitutionale | 22.79 (286.90) | 26.99 (292.76) | 21.02 (276.72) | 24.99 (282.07) | 0.006 |
| OASIS-based quality measures (OASIS episode level) | |||||
| Discharged to community, % | 72.8 | 73.1 | 70.1 | 71.8 | 0.059 |
| TNC change in self-care, mean (SD) | 1.37 (1.12) | 1.88 (1.19) | 1.28 (1.13) | 1.75 (1.20) | 0.080 |
| TNC change in mobility, mean (SD) | 0.43 (0.41) | 0.67 (0.46) | 0.41 (0.42) | 0.63 (0.47) | 0.060 |
| Improvement in dyspnea, % | 66.7 | 81.5 | 66.1 | 78.9 | 0.011 |
| Improvement in management of oral medications, % | 51.5 | 71.5 | 53.9 | 69.9 | –0.047 |
| Improvement in pain interfering with activity, % | 70.7 | 82.4 | 67.7 | 79.7 | 0.066 |
| HHCAHPS-based patient experience measures (agency level), %f | |||||
| How often the home health team gave care in a professional way (professional care), agency % mean (SD) | 88.8 (5.26) | 88.4 (5.58) | 88.2 (5.73) | 88.0 (6.35) | 0.111 |
| How well did the home health team communicate with patients (communication), agency % mean (SD) | 85.9 (6.09) | 85.5 (6.42) | 85.3 (6.32) | 85.2 (7.07) | 0.106 |
| Did the home health team discuss medicines, pain, and home safety with patients (discussion of care), agency % mean (SD) | 82.8 (7.10) | 82.0 (7.90) | 83.8 (7.08) | 83.3 (7.87) | –0.130 |
| How do patients rate the overall care from the home health agency (overall care), agency % mean (SD) | 84.4 (8.30) | 84.2 (8.37) | 83.7 (9.12) | 83.7 (10.10) | 0.091 |
| Would patients recommend the home health agency to friends and family (likely to recommend), agency % mean (SD) | 79.6 (10.02) | 78.7 (10.46) | 78.4 (11.06) | 77.7 (12.02) | 0.119 |
Abbreviations: ED, emergency department; FFS, fee for service; HH, home health; HHCAHPS, Home Health Consumer Assessment of Healthcare Providers and Systems; HHVBP, home health value-based purchasing; OASIS, Outcome and Assessment Information Set; PDGM, Patient Driven Groupings Model; SNF, skilled nursing facility; TNC, total normalized composite.
Baseline period was from January 1, 2013, to December 31, 2015; the intervention period was from January 1, 2016, to December 31, 2020.
Reflects total number of observations across the baseline and intervention periods. The sample size for each measure may be lower than these totals because of missing data or measure-specific reporting requirements. See eTable 8 in the Supplement for analysis-specific sample sizes.
Home health episodes were defined using information reported on home health FFS claims, with the episode start date corresponding to the home health “claim from” date, and the episode end date corresponding to the home health “claim through” date.
Reflects Medicare payments during the home health episode through 37 days following the date of the last home health visit. This table reflects the Medicare spending post-PDGM values; pre-PDGM values showed a similar trend.4
Includes Part B carrier and durable medical equipment claims.
Mean percentages and standard deviations were calculated with agency-level data for the patient experience measures, reflecting the agency-level percentage of survey respondents reporting favorable experience in each domain. The overall care measure reflects the percentage of respondents who rated the agency favorably with a 9 or 10 on a 10-point scale.