Multi-agency chains are playing a growing role in the home health sector, with important implications, according to a study published Monday in Health Services Research.

“Substantial differences in geographic distribution, patient composition, and quality performance were observed between chain‐ and nonchain HHAs,” the researchers wrote. “Examining the growth and performance of multi‐agency chains can help inform quality reporting and monitoring, assess payment adequacy, and facilitate greater transparency and accountability within the HHA marketplace.”

Overall, authors said, the number of home health agencies increased from 7,899 in 2015 to 10,818 in 2018.

For-profit chain‐owned home health agencies doubled in number during the study period, increasing from 903 (11.4% of all agencies) to 1,841 (17%). Such agencies also grew the most in the number of Medicare enrollees served, from 439,998 (12.9%) to 1.08 million (28.3%).

For‐profit nonchain agencies, on the other hand, had the fastest total-number growth rate, going from 4,293 (54.3%) to 7,337 (67.8%), And these agencies served the highest proportion of dually eligible beneficiaries (42.2%) and Blacks (27.9%). Also, in 2018, for‐profit nonchain agencies remained the largest category of agencies, at 67.8%, and served the largest number of Medicare enrollees, 40.7%.

Researchers used Medicare cost reports and the provider of services file to ascertain agency characteristics, and they used star ratings and the home health agency public use file to extract quality of care and patient characteristics.