Tracy M Mroz1, Ann Meadow2, Elizabeth Colantuoni3, Bruce Leff4, Jennifer L Wolff5. 1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: tmroz@uw.edu. 2. Office of Research, Development, and Information, Centers for Medicare & Medicaid Services, Baltimore, MD. 3. Department of Biostatistics, Johns Hopkins School of Medicine, Baltimore, MD. 4. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Geriatric Medicine, Johns Hopkins School of Medicine, Baltimore, MD. 5. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abstract
OBJECTIVE: To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. DESIGN: Retrospective analysis. SETTING: Home health agencies. PARTICIPANTS: Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. RESULTS: Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28). CONCLUSIONS: As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.
OBJECTIVE: To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. DESIGN: Retrospective analysis. SETTING: Home health agencies. PARTICIPANTS: Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. RESULTS: Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28). CONCLUSIONS: As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.
Authors: Kali S Thomas; Margot L Schwartz; Eric Boyd; Dolly P White; Angela B Mariotto; Michael J Barrett; Joan L Warren Journal: J Natl Cancer Inst Monogr Date: 2020-05-01
Authors: Ickpyo Hong; Sara Knox; Loree Pryor; Tracy M Mroz; James E Graham; Meredith F Shields; Timothy A Reistetter Journal: Am J Phys Med Rehabil Date: 2020-09 Impact factor: 3.412