The Rise of Community-Based Home Health

Researchers analyzed Medicare administrative data spanning 2017, 2019, and 2021, meticulously tracking home health episodes and their origins. Their analysis revealed substantial geographic variation in community-entry prevalence, ranging from 30% to 60% across different locations in 2019. Interestingly, with the exception of Texas, every state experienced an increase in community-entry episodes during the study period.

The study also uncovered a strong correlation between the growth of community-entry episodes and overall home health spending. States that saw limited growth in community-based care experienced the most significant reductions in per-beneficiary spending. This suggests that neglecting the needs of this growing population could lead to cost savings in the short term, but potentially at the expense of quality of care.

Patients entering home health from the community often grapple with chronic conditions and complex health challenges. Researchers found higher rates of Alzheimer’s disease, dementia, depression, and cognitive impairment among this group. These individuals also tend to require longer durations of care and are more likely to experience multiple episodes of home health services. What does this mean for the future of care coordination for these vulnerable populations?

The implementation of the Patient-Driven Groupings Model (PDGM) further complicated the landscape. Prior to PDGM, community entry accounted for 49% of all home health episodes, 48% of total spending, and 43% of beneficiaries in 2019. By 2021, these proportions had risen to over 50% of episodes, highlighting the increasing importance of understanding and appropriately funding community-based care.

The study’s authors emphasize that the current system’s focus on post-acute care may be misaligned with the realities of Medicare home health utilization. They argue that payment systems need to be re-evaluated to adequately support the distinct medical needs of community-entry patients. Furthermore, existing quality metrics may need to be revised to prioritize outcomes that are most relevant to this population.

Beyond payment and quality measures, the findings raise broader questions about the role of home health within the larger continuum of long-term care and support services. How can we better integrate home health with other community-based resources to provide comprehensive and coordinated care for individuals with chronic illnesses and disabilities?

The implications of this research extend beyond the immediate concerns of Medicare reimbursement. It underscores the need for a more holistic and patient-centered approach to home health care, one that recognizes the diverse needs of all beneficiaries, regardless of their entry point into the system.

For further insights into the evolving landscape of home health, consider exploring resources from the National Association for Home Care & Hospice and the Home Health Care News website.

Frequently Asked Questions About Medicare Home Health