Among post-acute care settings, home health achieved the best results in two quality measures: discharge to community and Medicare spending per beneficiary, according to the Centers for Medicare & Medicaid Services’ Health Equity Confidential Feedback National Summary Report.
The report compared the performance of home health agencies, inpatient rehabilitation facilities, long-term care hospitals and skilled nursing facilities. Discharge to community and spending per beneficiary, the two quality reporting measures examined in the report, together capture information about patient outcomes and the efficiency of care. For both, home health earned top marks.
Home health had the highest rate of successful discharge to community, which takes into account providers’ share of patients discharged to their community without any unplanned hospitalizations or mortality within 31 days. For non-dual-eligible patients, home health providers had an average discharge to community score of 77.2%, compared with 67.6% for inpatient rehabilitation facilities, 53% for skilled nursing facilities and 19.6% for long-term care hospitals.
CMS also compared discharge to community data stratified by patients’ race and ethnicity. While still high, home health agencies’ discharge to community rates were lower for non-white beneficiaries than white beneficiaries.
Home health achieved these outcomes at a lower price point than other settings. Average Medicare spending per beneficiary per treatment period was just under $12,000, on average, for home health agencies. Meanwhile, spending per beneficiary was around $36,000 for inpatient rehabilitation facilities, $29,000 for skilled nursing facilities and $83,000 for long-term care hospitals.
Home health providers generally served patients in urban areas better and more efficiently than those living in rural places, according to the report. Discharge to community scores were slightly higher, and spending per beneficiary was slightly lower, for urban-dwelling beneficiaries than rural-dwelling individuals using home health services. This is in line with previous research suggesting that residents of rural areas often receive less home healthcare. These rural areas also tend to have fewer clinicians practicing home-based care, a study from last year found.
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