Home Health & Hospice Week

Want lower hospital costs? Use home visits.

While home health agencies are under everincreasing reimbursement and regulatory scrutiny, multiple studies and pilot programs are proving the benefit saves Medicare money.

Case #1: The Centers for Medicare & Medicaid Services Office of Minority Health has issued a “Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries,” in which two of the three readmission-preventing models features home care. The guide, developed in conjunction with the Disparities Solutions Center in the Mongan Institute for Health Policy at Massachusetts General Hospital in collaboration with the NORC at the University of Chicago, outlines one program run by non-profit health system KentuckyOne Health. The Health Connections Initiative, based on the model developed by Camden Coalition of Healthcare Providers, aims at increasing coordination of services for so-called “super-utilizers” — patients having four or more inpatient, outpatient, or emergency room visits resulting in an admission in a one-year period. Under the program operated by VNA Nazareth Home Care, enrollees receive frequent home visits after discharge for up to 90 days. In addition to medical needs, a multidisciplinary team focuses on needs like housing, transportation, food insecurity, and low literacy. Each care team includes a lead RN, a licensed practical nurse, a social worker, and two community health workers who collaborate with each participant’s primary care provider. A dietician and interpreter are used as needed.

The program showed readmission rates decreased significantly by 17 percent, from 29.7 percent to 12.8 percent, CMS notes in the guide.

Depression rates also fell from 6.73 to 3.65, selfefficacy and ability to manage health rose from 4.7 to 7.86, perception of care coordination increased from 4.1 to 4.64, and patient satisfaction grew from 4.12 to 4.70, CMS says.

Case #2: Also in the guide, CMS outlines a home health disease management program for diabetes and cardiovascular disease run by Alterna-Care Home Health. Under the program, a specialty home health nurse received additional training in managing the specific diagnosis and worked with physician collaborators, patients’ primary care docs, and LPNs. Three home visits were provided for patient education on diabetes, and patients used telehealth equipment to transmit their blood glucose levels daily. Patients failing to transmit received phone calls walking them through the process.

The program reduced hospitalizations for diabetes patients by 51 percent and emergency room visits by 17.5 percent, CMS says. Hospitalizations for cardiac patients also significantly decreased. See details of the programs and guidelines for readmission prevention in the report at www.cms.gov/About-CMS/Agency-information/OMH/Downloads/OMH_Readmissions_Guide.pdf.

Case #3: A study commissioned by the Home Care & Hospice Association of New Jersey and conducted by Quality Insights shows that 25 percent of New Jersey patients who were discharged from a hospital returned to the hospital within 30 days when they didn’t have home health services, compared with 17 percent of those who did utilize home care, reports the NJBIZ newspaper.

If all patients who received home care referrals used the benefit, Medicare could have saved $6.9 million on hospital readmissions in the state, the study contends. “Those of us in the home care industry have known for a long time that home health care leads to lower rates of readmittance and greater savings to our health care system. And now a careful look at the data proves this point,” association President Chrissy Buteas said, according to the newspaper.

Case #4: A study published back in December in the Health Affairs journal showed the costsaving value of home visits. In the study by RAND Corp., a HouseCalls program operated by Optum, UnitedHealthGroup’s IT-enabled health services business, worked in much the same way as similar HHA-operated readmission reduction programs. HouseCalls sent a physician or nurse practitioner to a Medicare recipient’s home to provide a comprehensive geriatric assessment, with referrals to community providers and health plan resources to address uncovered issues.

The study, which evaluated Medicare beneficiaries eligible for the HouseCalls program during 2008 through 2012 in Arkansas, Georgia, Missouri, South Carolina and Texas, found that Medicare recipients enrolled in the program had 14 percent fewer hospital admissions and a lower risk of admission to nursing homes over the 12 months after they were evaluated, when compared to other Medicare recipients enrolled in traditional fee-for-service health programs. Patient visits to physicians did increase, however, RAND notes in a release.

See the study abstract at http://content.healthaffairs.org/content/34/12/2138.abstract.