Home Health & Hospice Week

If you can’t figure out why home health spending fluctuates greatly from place to place, you’re not alone — a new American Journal of Managed Care study can’t figure it out either. And that’s probably bad news for home health agencies.

Researchers led by Robert Schuldt of the University of Arkansas for Medical Sciences examined county-level Medicare home health expenditures per home health beneficiary, according to the study’s abstract. “Significant variation in home health expenditures was identified across county quintiles, with a 90th-to-10th-percentile expenditure ratio of 2.5,” the study found. In other words, “a 2.5-fold spending difference per beneficiary exists between the 90th and 10th spending percentiles,” the study explains.

“Patient characteristics explained only 16 percent of the variation in home health expenditures,” the study claims. That means “more than 40 percent of spending variation remained unexplained in the study, suggesting substantial inefficiency and waste in the home health care program.”

The study authors suggest “the physician referral system should be strengthened, either through incentivizing physicians to perform more meaningful assessments or through assignment of legal responsibility to physicians to certify the referral process.”

And the researchers advocate imposing patient copays to reduce “unnecessary preference-sensitive home health care utilization.” Finally, Medicare should work with states to standardize care and utilization, the authors suggest.

The study is online at www.ajmc.com/view/geographic-variation-in-medicare-home-health-expenditures.