Home Health Saves $15,233 per Patient while Improving Survival

Physician Bulletins: Below, you will find a sample of the community-based healthcare utilization bulletins that we routinely mail to referring doctors and other healthcare professionals.

In April, The American Journal of Medicine published a study reviewing the files of 17,629 patients discharged from the Cleveland Clinic. Researchers set out to evaluate the effect of home health on healthcare resource utilization.¹ Their subjects included 6,363 patients discharged to home health and 11,266 matched controls who elected self-care at discharge.

During the 365 days following discharge, patients who received home health services spent $15,233 less on health care compared to the patients who elected self-care. This was in absolute dollars. After adjusting for covariates, researchers tallied the one-year savings associated with home health at $6,433. These savings ac-crued despite the fact that Medicare pays 100% for home health services with no co-pay or deductibles for patients.

Savings were generated in part through reduction of readmissions. Home health services correlated with an 18% reduction in the rate of hospital readmissions. However, savings also occurred simply through improved overall health. Patients in the home health group had a 20% lower mortality rate.

Home health performed better with some disease types. The mortality rate reduction for digestive diseases was 28%. The readmission rate reduction for neurological diseases was 33%. The adjusted savings for heart disease were nearly double the average across all diseases ($11,453).

The authors note that this was the first report investigating the utility of home health among a large and di-verse patient base. When referring to reports in peer-reviewed journals, this is true. However, a larger indus-try study commissioned by CMS and the US Department of Health & Human Services had similar findings in 2016.² In that study, researchers accessed the Medicare billing records for every 2014 hospital discharge in New Jersey that received a home health referral – 36,964 cases. One-third did not receive home health. Home Health services correlated with a 30% reduction in 30-day rehospitalization rates. Previous studies demonstrating how home health reduces readmissions focused on specific care paths: dyad interventions for stroke survivors,³ nutritional intervention,⁴ A1c management,⁵ home nursing following coronary artery bypass graft,⁶ etc.

Leading Texas in
Preventing Urgent Care

Compared to other home health agencies in Texas, Avatar prevents urgent care better. Medicare’s Home Health Compare shows that the patients you refer to Avatar prove 35% less likely to need emergency room care during the home health episode. Medicare risk adjusts these numbers so agencies can be compared fairly. The prevention of unplanned hospital visits serves as a good indicator of the overall quality of care your patients receive at Avatar.

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1. Xiao R, Miller J, Zafirau W, et al. Impact of home health care on health care resource utilization following hospital discharge: a cohort study. The American Journal of Medi-cine. 2018; 131 (4): 395-407.
2. Quality Insights. New Jersey Home Health Readmission Report. US Dept Health Hu-man Services. 2016; Pub QI-C3-112015.
3. Bakas T, Clark P, Kelly-Hayes M, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Asso-ciation and American Stroke Association. Stroke. 2014; 45 (9): 2836-2852.
4. Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients re-ceiving home care. Clinical Nutrition. 2010; 29 (1): 47-53.
5. Centers for Medicare & Medicaid Services. Response to Comments for Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus. 2014; LCDs L35413 and L35132.
6. Hall M, Esposito R, Pekmezaris R, et al. Cardiac surgery nurse practitioner home vis-its prevent coronary artery bypass graft readmissions. Ann Thorac Surg. 2014; 97: 1488-95.