Home Health & Hospice Week

More patients should be discharged home due to comparable outcomes, lower cost, editorial suggests.

Home care providers often use their cost effectiveness and ability to prevent rehospitalizations as a selling point and argument for better funding. But a new study says another setting is actually better at preventing readmissions.

A study that looked at more than 17 million hospitalizations of Medicare beneficiaries found that “compared with discharging patients to skilled nursing facilities, discharging patients to home with home health care was associated with a higher 30-day rate of readmission,” says the study published in the journal JAMA Internal Medicine.

Specifically, “discharge to home was associated with a 5.6-percentage point higher rate of readmission at 30 days compared with discharge to a skilled nursing facility,” the abstract says.

On the bright side: The discharges to home care showed “significantly lower Medicare payment for initial postacute care and for the total 60-day episode of care including hospitalization, all postacute care, and subsequent readmissions,” continues the study abstract. “There were no significant differences in 30-day mortality rates or improved functional status,” adds the study led by University of Pennsylvania researchers.

Bottom line: “Those discharged to home had slightly higher rates of rehospitalization but lower 90-day Medicare costs than did those transferred to a SNF,” notes an accompanying editorial in the journal.

Despite the increased cost and comparable outcomes, “almost twice as many Medicare benefi­ciaries were discharged to a SNF than to home with home health care,” the editorial highlights. “Although those discharged to a SNF were, on average, older, sicker, and more frail than those discharged to home with home health care, the overlap between the 2 populations is substantial, raising the question of why more patients do not go home after discharge.”

The abstract and link to the editorial are at https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2727848.