Outcome quality in Home Health: Role of organizational and market factors

In the last decade, number of home health agencies (HHAs) has increased by two-third, and the payment models have evolved towards quality performance based reimbursement models. This study aims to determine the relationship of organizational characteristics, and market conditions with outcome quality, specifically risk-standardized rates of patients - receiving any emergency care without hospitalization, discharged from home health care, and admitted to an acute care hospital. A balanced panel data for the period 2007-2011 on 7000 HHAs’ characteristics and quality performance were obtained from Home Health Compare, and market characteristics at hospital referral regions (HRR) level were obtained from CMS-Healthcare Indicator Warehouse, including market demand (measured as percentage beneficiaries using post-acute care, total count of Medicare beneficiaries), direct competition (number of HHAs within HRR), substitutive competition (percentage beneficiaries using post-acute care services from alternate providers including long–term care, skilled nursing, and rehabilitation facilities). The balanced panel was analyzed using fixed effects linear panel model accounting for temporal and spatial correlation.  

Our findings suggest that all three patient outcomes are moderately better for home health agencies offering higher service mix, and that are non-profit, i.e., lower rates of hospitalization, and emergency care without hospitalization, and higher discharge rate to home. The agencies facing higher direct competitive market (from other HHAs) and with larger market penetration have moderately better patient outcomes, however competition from alternate providers has mixed association.

These results can inform policymaking and guidelines development to manage and improve resource constrained home healthcare in the wake of aging population.