Are Patient Experience and Outcomes for Home Health Agencies Related?

2020 ◽  
pp. 107755872096836
Author(s):  
Margot L. Schwartz ◽  
Tracy M. Mroz ◽  
Kali S. Thomas
Keyword(s):  
Outcome Measures ◽  
Patient Experience ◽  
Selection Process ◽  
Health Agency ◽  
Home Health ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Individual Outcome ◽  
The Difference ◽  
Reported Data

To facilitate home health agency (HHA) selection, CMS released patient experience star ratings on the Home Health Compare website in January 2016. Our objective was to understand the relationship between patient experience and outcomes in HHAs. We utilized publicly reported data to evaluate the relationships among patient experience star ratings, summary quality of care star ratings (comprised primarily of outcome measures), and individual outcome measures for 4,249 HHAs. Results indicate a weak correlation between patient experience and quality stars ( r = .13, p < .001). The difference between the lowest and highest rated HHAs for patient experience is associated with only a half-star improvement in quality stars. The associations between patient experience and individual outcome measures varied, with functional outcomes most strongly associated with patient experience. Findings highlight the importance of reporting separate quality domains; however, conflicting ratings may complicate the HHA selection process and introduce misaligned incentives for HHAs.

scholarly journals THE RELEASE OF TECHNICAL QUALITY AND PATIENT EXPERIENCE STAR-RATINGS FOR HOME HEALTH AGENCIES AND AGENCY SELECTION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S602-S602
Author(s):  
Margot L Schwartz ◽  
Momotazur Rahman ◽  
Kali S Thomas ◽  
R Tamara Konetzka ◽  
Vincent Mor
Keyword(s):  
Patient Experience ◽  
Choice Model ◽  
Health Agency ◽  
Home Health ◽  
Fee For Service ◽  
Technical Quality ◽  
Policy Makers ◽  
Star Rating ◽  
Home Health Agencies ◽  
Choice Set

Abstract To facilitate informed Home Health Agency (HHA) selection for the 3.5 million annual Medicare home health (HH) users, CMS introduced technical quality and patient experience summary star-ratings on the Home Health Compare website in July 2015 and January 2016. There is no information about the relationship between the introduction of these two unique sets of star-ratings and HHA selection. We utilized a conditional logit, discrete choice model, which accounts for all HHAs that each patient could have selected (their “choice-set”) based on ZIP codes, to assess this relationship. We selected a random 5% sample (203,966 admissions) of new Medicare Fee-for-Service HH admissions that occurred in the year before, or the year after star-ratings were released. Star-ratings were obtained from the HH Compare website and categorized as low (=4 stars). We found the introduction of HHA star-ratings was associated with an increased likelihood of selecting an HHA with a high technical quality star-rating, and a decreased likelihood of selecting an HHA with a high patient experience star-rating. After controlling for each patient’s choice-set, patients had 19% increased odds (OR 1.19, 95% CI:1.16,2.23) of selecting a high technical quality HHA and a 12% decreased odds (OR 0.88, 95% CI:0.84,0.92) of selecting a high patient experience HHA, compared to low quality HHAs. Findings suggest patients and referring providers may prioritize technical quality over patient experience. Policy-makers should provide resources to enable HH patients to utilize and interpret the two different HHA star-ratings.

scholarly journals Patient-Rated Performance of Home Health Agencies and Hospitalization Risk: A Propensity-Score Matched Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 536-536
Author(s):  
Chenjuan Ma ◽  
Lisa Groom ◽  
Shih-Yin Lin ◽  
Daniel David ◽  
Abraham Brody
Keyword(s):  
Health Care ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Patient Experience ◽  
Home Health Care ◽  
Healthcare Providers ◽  
Home Health ◽  
High Performing ◽  
Health Agencies ◽  
Home Health Agencies

Abstract Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.

Early Effects of Home Health Value-Based Purchasing on Quality Star Ratings

2020 ◽  
pp. 107755872095229
Author(s):  
Salom M. Teshale ◽  
Margot L. Schwartz ◽  
Kali S. Thomas ◽  
Tracy M. Mroz
Keyword(s):  
Patient Care ◽  
Patient Experience ◽  
Quality Measures ◽  
Home Health ◽  
Value Based Purchasing ◽  
Health Value ◽  
Quality Of Patient Care ◽  
Health Agencies ◽  
Home Health Agencies

The Home Health Value-Based Purchasing Model (HHVBP) is a new Medicare model wherein home health agencies compete to achieve higher reimbursements by demonstrating improved value according to clinical and patient experience-related quality measures. Many measures used in HHVBP overlap with measures used in quality star ratings for home health agencies. Thus, improvements in quality measures used in HHVBP may also be reflected in changes in star ratings. However, it is unclear whether agencies competing in HHVBP improve their Centers for Medicare & Medicaid Services star ratings compared with those not competing. Using publicly available data from Centers for Medicare & Medicaid Services, we evaluated the effect of HHVBP on quality of patient care and patient experience composite star ratings over a 2-year period using a difference-in-differences analysis. We found evidence for a small, statistically significant increase in quality of patient care star ratings for agencies participating in HHVBP, and no effect on patient experience ratings.

scholarly journals Identifying Associations between Quality Initiatives and Quality Measures among Home Health Agencies: Findings from a National Study

2021 ◽  
Vol 14 ◽  
pp. 117863292199209
Author(s):  
Jacqueline S Zinn ◽  
Heather Ladd ◽  
Eugene Nuccio ◽  
Susan L Ettner ◽  
Dara H Sorkin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Support Groups ◽  
Patient Experience ◽  
Quality Measures ◽  
Home Health ◽  
National Study ◽  
Quality Initiatives ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Improved Performance

Home health performance gained visibility with the publication of Home Health Compare and the Home Health Value-Based Payment demonstration. Both provide incentives for home health agencies (HHA) to invest in quality improvements. The objective of this study is to identify the association between quality initiatives adopted by HHAs and improved performance. A 2018 national survey of 7459 HHAs, yielding a sample of 1192 eligible HHAs, provided information about 23 quality initiatives, which was linked to 5 composite Super Quality Measures (SQMs): ADL/pain, self-treatment, timely care, hospitalizations, and patient experience. Exclusions for missing data and outliers yielded a final analytical sample of 903 HHAs. Regression models estimated associations between quality initiatives and SQMs. The relationships between sixteen of the SQM/quality initiative pairs were positively associated with improvement and 7 were negatively associated. Web-based technologies for staff and care-givers improved performance but deteriorated patient experience. Web support-groups for staff and review of HHC rankings reduced hospitalization rates. While this study offers insights for quality improvement, a limitation may be a lack of sensitivity to the nuances of quality improvement implementation. Therefore, this study should be viewed as hypothesis-generating concerning initiatives likely to have the greatest potential meriting further investigation.

Patient experience and process measures of quality of care at home health agencies: Factors associated with high performance

2017 ◽  
Vol 36 (1) ◽  
pp. 29-45 ◽  
Author(s):  
Laura M. Smith ◽  
Wayne L. Anderson ◽  
Lisa M. Lines ◽  
Cristalle Pronier ◽  
Vanessa Thornburg ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Patient Experience ◽  
High Performance ◽  
Home Health ◽  
Process Measures ◽  
Factors Associated ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Care At Home

Home Health Agencies: Empirical Evidence on the Patient-Driven Groupings Model’s Expected Effects on Agency Reimbursements

2021 ◽  
pp. 108482232199038
Author(s):  
Elizabeth Plummer ◽  
William F. Wempe
Keyword(s):  
Ordinary Least Squares ◽  
Process Quality ◽  
Home Health ◽  
Least Squares Regression ◽  
Residual Variation ◽  
Health Agencies ◽  
Dual Eligible ◽  
Home Health Agencies ◽  
Seriously Ill Patients ◽  
Seriously Ill

Beginning January 1, 2020, Medicare’s Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies’ (HHAs’) reimbursements. Instead, PDGM advances Medicare’s shift toward value-based payment models by directly linking HHAs’ reimbursements to patients’ medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs’ pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM’s likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs’ expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.

scholarly journals Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 914-914
Author(s):  
Christine Jones ◽  
Jacob Thomas ◽  
Marisa Roczen ◽  
Kate Ytell ◽  
Mark Gritz
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Transitional Care ◽  
Care Transitions ◽  
Home Health ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Readmission Rates ◽  
Health Agencies ◽  
Home Health Agencies

Abstract For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p &lt;0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.

Disaster Preparedness for Vulnerable Persons Receiving In-Home, Long-Term Care in South Carolina

2008 ◽  
Vol 23 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Sarah B. Laditka ◽  
James N. Laditka ◽  
Carol B. Cornman ◽  
Courtney B. Davis ◽  
Maggi J. Chandlee
Keyword(s):  
Health Care ◽  
South Carolina ◽  
Home Health Care ◽  
Disaster Planning ◽  
Home Health ◽  
Personal Care ◽  
Term Care ◽  
Care Services ◽  
Health Agencies ◽  
Home Health Agencies

AbstractPurpose:The purpose of this study was to examine how agencies in South Carolina that provide in-home health care and personal care services help older and/or disabled clients to prepare for disasters.The study also examines how agencies safeguard clients' records, train staff, and how they could improve their preparedness.Methods:The relevant research and practice literature was reviewed. Nine public officials responsible for preparedness for in-home health care and personal care services in South Carolina were interviewed. A telephone survey instrument was developed that was based on these interviews and the literature review. Administrators from 16 agencies that provide in-home personal care to 2,147 clients, and five agencies that provide in-home health care to 2,180 clients, were interviewed. Grounded theory analysis identified major themes in the resulting qualitative data; thematic analysis organized the content.Results:Federal regulations require preparedness for agencies providing inhome health care (“home health”). No analogous regulations were found for in-home personal care. The degree of preparedness varied substantially among personal care agencies. Most personal care agencies were categorized as “less” prepared or “moderately” prepared. The findings for agencies in both categories generally suggest lack of preparedness in: (1) identifying clients at high risk and assisting them in planning; (2) providing written materials and/or recommendations; (3) protecting records; (4) educating staff and clients; and (5) coordinating disaster planning and response across agencies. Home health agencies were better prepared than were personal care agencies.However, some home health administrators commented that they were unsure how well their plans would work during a disaster, given a lack of training. The majority of home health agency administrators spoke of a need for better coordination and/or more preparedness training.Conclusions:Agencies providing personal care and home health services would benefit from developing stronger linkages with their local preparedness systems. The findings support incorporating disaster planning in the certification requirements for home health agencies, and developing additional educational resources for administrators and staff of personal care agencies and their clients.

Increasing Home Health Face-to-Face Certification: Impact of a Hospital-Based Intervention

2018 ◽  
Vol 30 (3) ◽  
pp. 110-115
Author(s):  
Kimberly Pelland ◽  
Emily Cooper ◽  
Alyssa DaCunha ◽  
Kathleen Calandra ◽  
Rebekah Gardner
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Home Health ◽  
Hospitalized Patients ◽  
Post Intervention ◽  
Face To Face ◽  
Hospital Physicians ◽  
Health Agencies ◽  
Community Physician ◽  
Home Health Agencies

Medicare requires that home health patients have a face-to-face visit with a physician when services are initiated and that physicians provide certification of this encounter before home health agencies (HHAs) can be reimbursed. We assessed an intervention to increase completion of face-to-face certification by hospital physicians at discharge using a retrospective chart review. We found a shift in the source and timeliness of certification among intervention hospitals. Pre-intervention, hospital physicians completed face-to-face certifications for 18.7% of patients and community physicians completed certifications for 47.2% ( p < .001), compared with 44.4% and 24.3% ( p < .001) post-intervention. Shifting the source of certification from community to hospital physicians helped HHAs by reducing the burden of tracking down certification from community physician offices and facilitating timely care for recently hospitalized patients.

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