254673 Show Me the Money: The Relationship Between Home Care Ownership Status and Quality of Care

Monday, October 29, 2012

William Cabin, PhD, JD, MPH, MSW , Social Work and Gerontology Programs, Richard Stockton College, Pomona, NJ
To date, studies of hospitals, health maintenance organizations, nursing homes, and dialysis provide have found that proprietary ownership may be associated with poor care and, for hospitals, with higher costs. However, there are no studies of the relationship of ownership status to quality in Medicare-certified home health agencies (hhas) (Christman, 2011; Dey, et al., 2011). Investor-ownership of home health merits policy attention for several reasons. First, home health expenditures have grown by 123% since the creation of the Medicare home health prospective payment system(PPS) in October 2000, from $ 8.5 Billion in 2000 to $ 19 Billion in 2009[Medicare Payment Advisory Commission (MedPac), 2011]. Second, Medicare home health enrollment has increased by 32%, from 2.5 million enrollees in 2000 to 3.3 million in 2009 (MedPac, 2011). Third, PPS has generated significant profits to hhas, averaging 17.7% in 2009, the highest among all Medicare provider types, except skilled nursing facilities at 18.1% (MedPac, 2011), raising concerns about resource diversion from patient care needs.. Fourth, proprietary hhas' profit margins are 30% higher than non-profits hhas, averaging 18.7%% compared to 14.4% for non-profits in 2009 (MedPac, 2011). Fifth, proprietary agencies have grown rapidly, representing 84% of all Medicare-certified hhas , compared to 42% in 2000 (MedPac, 2011; National Association for Home Care & Hospice, 2011). Sixth, an analysis by the Senate Finance Committee suggested that proprietary agencies gamed PPS , possibly employing fraudulent techniques United States Senate Finance Committee, 2011). Seventh, Medicare created a public Home Health Compare (HHC) database from PPS patient assessment data, making quality comparison by ownership status feasible (Centers for Medicare & Medicaid Services, 2011).The paper presents the first study of HHC database based on ownership status, finding a statistically significant relationship between ownership status and aggregate quality outcomes with proprietary agencies having lower aggregate scores.

Learning Areas:
Provision of health care to the public
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
1.Describe how quality of care is measured by the federal government for Medicare-certified home care agencies. 2.Demonstrate the ownership status has a statistically-significant relationship to home care quality outcomes.

Keywords: Health Care, Home Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have previously presented at APHA and other professional conferences and have two Masters degrees.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.