TY - JOUR
T1 - Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions
AU - Mroz, Tracy M.
AU - Meadow, Ann
AU - Colantuoni, Elizabeth
AU - Leff, Bruce
AU - Wolff, Jennifer L.
N1 - Funding Information:
Supported in part by the American Occupational Therapy Foundation Dissertation Research Grant Program. The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the article for publication.
Publisher Copyright:
© 2017 American Congress of Rehabilitation Medicine
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/6
Y1 - 2018/6
N2 - 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.
AB - 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.
KW - Health services research
KW - Home care services
KW - Medicare
KW - Quality of care
KW - Rehabilitation
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U2 - 10.1016/j.apmr.2017.08.483
DO - 10.1016/j.apmr.2017.08.483
M3 - Article
C2 - 28943160
AN - SCOPUS:85034644581
SN - 0003-9993
VL - 99
SP - 1090-1098.e4
JO - Archives of physical medicine and rehabilitation
JF - Archives of physical medicine and rehabilitation
IS - 6
ER -