For-Profit Medicare Home Health Agencies’ Costs Appear Higher And Quality Appears Lower Compared To Nonprofit Agencies

Cabin, William D.; Himmelstein, David U.; Siman, Michael L.; Woolhandler, Steffie

doi:10.1377/hlthaff.2014.0307

Cited by 52 publications

(60 citation statements)

References 17 publications

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“…However, given the more favorable case mix of patients, the lower rates of pain-free status at discharge and of pain improvement found at for-profit agencies strongly suggest a lower quality of pain management at these agencies. This is consistent with the lower or comparable quality of home health care associated with for-profit status found in a previous study 41 and different patterns of service provision by profit status of hospice agencies. 42 …”

Section: Discussionsupporting

confidence: 92%

Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Meagan

Reid

Inturrisi

et al. 2016

Journal of Pain and Symptom Management

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Context Knowledge is limited regarding pain assessment and management practices, as well as pain-related outcomes in hospice care. Objectives To generate national estimates of pain assessment and management practices and outcomes of pain control among patients 65 years or older receiving hospice care in the U.S. and identify hospice discharge and agency characteristics predicting study outcomes. Methods The 2007 National Home Health and Hospice Care Survey was analyzed. Multivariate logistic regressions were estimated to identify discharge and agency characteristics predicting guideline-concordant pain assessment and management practices and pain control outcomes. Results A high percentage of discharges had pain assessment at admission (97%) and before discharge (93%); use of valid pain rating scales was relatively low (69% and 54% for first and last assessments, respectively). Almost 95% of patients received pain medication, but only 42% received nonpharmacologic therapies. About 70% of patients assessed with a valid pain scale saw improvement in the level of pain or remained free of pain from admission to discharge. Non-Hispanic blacks were less likely to have pain assessments, and Hispanics were less likely to receive opioid analgesics or to have pain-free status at discharge, compared with non-Hispanic whites. Patients receiving care from for-profit (vs. nonprofit) agencies were more likely to receive pain assessment with a valid scale before discharge but less likely to experience pain control or improvement. Conclusion Greater use of valid pain assessment scales and nonpharmacologic therapies constitutes areas for improvement in hospice care. Targeted interventions are needed to address disparities in pain care by patient race and/or ethnicity and agency ownership status.

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Section: Discussionsupporting

confidence: 92%

Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Meagan

Reid

Inturrisi

et al. 2016

Journal of Pain and Symptom Management

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“…This study suggests that specific agency‐level characteristics are associated with performance, including Medicare certification and offering full as opposed to partial services. The finding that proprietary ownership of agencies is associated with a low‐performing score extends prior studies and provides a more‐contemporary assessment at the national level. For example, the 2003–07 home health care data were used to assess changes in agency performance after the initiation of Home Health Compare, and it was found that nonprofit agencies showed greater improvement on some quality measures than their counterparts .…”

Section: Discussionsupporting

confidence: 77%

“…Better performance may lead to better care. The association between nursing home and home health performance in quality of care and outcomes has been studied . For example, one study found that individuals receiving care in higher‐quality skilled nursing facilities had lower readmission rates (18%) than those in lower‐quality skilled nursing facilities (22%) .…”

Section: Discussionmentioning

confidence: 99%

“…For example, the 2003–07 home health care data were used to assess changes in agency performance after the initiation of Home Health Compare, and it was found that nonprofit agencies showed greater improvement on some quality measures than their counterparts . Another study used national cost and case mix–adjusted quality outcomes data and found that for‐profit agencies had higher costs but poorer performance than nonprofit agencies . The negative association between an agency's performance and its distance from patient homes may reflect the need for staff to travel long distances, which may restrict their ability to provide high‐quality care and increase staff turnover rates .…”

Section: Discussionmentioning

confidence: 99%

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Home Health Agency Performance in the United States: 2011–15

Wang

Spatz

Tariq

et al. 2017

J American Geriatrics Society

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OBJECTIVES To evaluate home health agency quality performance. DESIGN Observational study. SETTING Home health agencies PARTICIPANTS All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. MEASUREMENTS Twenty-two quality indicators, five patient survey indicators, and their composite scores. RESULTS The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011–12 to 2014–15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. CONCLUSION Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care.

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“…Patients' length of enrollment in home health care was longer under the fee‐for‐service payment system if they were served by a for‐profit agency (Grabowski et al , ; Han et al , ). For‐profit agencies incurred higher expenditures, but provided worse quality of care under the PPS (Cabin et al , ).…”

Section: Introductionmentioning

confidence: 99%

Practice Patterns among Entrants and Incumbents in the Home Health Market after the Prospective Payment System was Implemented

Kim

Norton

2015

Health Economics

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Home health care expenditures were the fastest growing part of Medicare from 2001-2009, despite the implementation of prospective payment. Prior research has shown that home health agencies adopted two specific strategies to take advantage of Medicare policies: provide at least 10 therapy visits to get an enormous marginal payment and recertify patients for additional episodes. We study whether there is heterogeneity in the adoption of those strategic behaviors between home health agency entrants and incumbents and find that entrants were more likely to adopt strategic practice patterns than were incumbents. We also find that for-profit incumbents mimicked one of the practice patterns following entrants in the same market. Our findings suggest that it is important to understand the heterogeneity in providers' behavior and how firms interact with each other in the same market. These findings help explain the rapid rise in expenditures in the home health care market.

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For-Profit Medicare Home Health Agencies’ Costs Appear Higher And Quality Appears Lower Compared To Nonprofit Agencies

Cited by 52 publications

References 17 publications

Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Home Health Agency Performance in the United States: 2011–15

Practice Patterns among Entrants and Incumbents in the Home Health Market after the Prospective Payment System was Implemented

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