Survey findings comparing treatment vs. control home health pay-for-performance demonstration participants

Background: The CMS-sponsored HHP4P Demonstration project included 570 HHAs from seven states in four regions beginning in CY2008. The evaluation of the Demonstration's effectiveness included the collection of qualitative data to explore what agencies did to achieve higher better patient outcomes. Research Question: “What differences occurred during Year 1 of the Demonstration between treatment and control HHAs in organization policies and clinical practices as reported on a Web-based survey, and how are these related to patient outcomes?” Research Methods: All 570 HHAs received information packets and a total of 116 Treatment and 103 Control HHAs completed their respective surveys. Principal Findings: • Demonstration participation resulted in minimal to no increase in costs. • HHAs received assistance in reducing acute care hospitalization (ACH) from the QIOs. • HHAs that were part of a larger corporate organization received corporate help to reduce ACH. • Treatment HHAs are more likely than control HHAs to have implemented a policy to increase the quantity and/or quality of communication with patients. • Control HHAs are more likely than treatment HHAs to have changed their policies regarding productivity requirements for staff members and add staff functions. • HHAs believed that the Demonstration would have the greatest positive impact on ACH and management of oral medications.

Implications for Policy/Practice/Delivery: The lack of difference between treatment and control HHAs in survey responses may or may not impact the effectiveness of the Demonstration. An alternative comparison would be to compare outcome performance for implementers vs. non-implementers regardless of group.