Home Health Care Providers Increase, But Geographic Variability Persists

MedicalResearch.com Interview with:
Sheila Eckenrode RN, CPHQ
Quality Improvement Consultant
The New England QIN-QIO
Qualidigm, Wethersfield, Connecticut

MedicalResearch.com: What is the background for this study?

Response: Post-acute care has become a focus for improving quality and cost effectiveness of healthcare in the United States. Changes in Medicare payment systems such as bundled payments and the emergence of Affordable Healthcare Organizations will most likely lead to expansion of post-acute care services and decrease in acute care hospitalizations. Approximately 30% of hospitalized Medicare beneficiaries were referred to home health care at discharge in 2012. In 2013, home health agencies served 3.5 million beneficiaries with Medicare paying $18 billion for these services. Home health care has been emphasized under the Improving Medicare Post-Acute Care Transformation Act of 2014 to provide and improve care at individual patient and community levels. In anticipation of increasing utilization of home care services, our study aimed to demonstrate the overall growth in home care availability as well as identify geographical variation and potential gaps in service.

MedicalResearch.com: What are the main findings?

Response: The number of Medicare-certified home health agencies has increased over the last decade, from approximately 7,500 in 2000 to more than 12,000 in 2015, and the number of patients served increased from 2.5 million in 2000 to 3.5 million in 2013. We found a nearly 3% per measure period increase in the availability of home health care from 2002-2003 through 2014-2015. We observed that the rate of ZIP codes lacking home health care decreased from 2.0% in 2002-2003 to 0.5% in 2014-2015. We also observed considerable geographic variation in care, with West, Northeast, and South Atlantic divisions having lower home health availability when compared to the Central divisions.

MedicalResearch.com: What should readers take away from your report?

Response: The availability of home care has steadily increased over the last decade in response to increased demand. However, considerable geographic variation in availability exists and should be considered in any national quality strategy or payment program design.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further research into geographic variation in utilization of homecare by patients, including successful completion of an episode of care may reveal as yet unexplained regional differences in patient and clinician attitudes towards homecare.


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National Trends and Geographic Variation in Availability of Home Health Care: 2002–2015
Yun Wang PhD,Erica C. Leifheit-Limson PhD,Jonathan Fine MD,Michelle M. Pandolfi MBA, LMSW, LNHA,Yan Gao BS,Fanglin Liu BA, MBA,Sheila Eckenrode MA, RN,Judith H. Lichtman PhD
Journal of the American Geriatrics Society
First published:21 March 2017Full publication history

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