When Seeking Value, Look to Home Health Care

In a recent communication, former Acting Administrator for the Center for Medicare & Medicaid Services Andy Slavitt said, “Home Health Agency services are a critical part of the health care continuum and are instrumental in helping a patient with Medicare benefits recover after an illness or injury.”

I couldn’t agree more.

Home health care provides skilled care in the setting patients prefer most and is central to our nation’s drive toward more coordinated, efficient, outcomes-driven care, leading the way with patient-centric programs that stand to transform the way care is delivered.

For instance, home health agencies have played a central role in CMS’ Comprehensive Care for Joint Replacement model, which works toward better outcomes for patients undergoing lower extremity joint replacement surgeries. Under the program, Medicare makes a single payment for all services provided during a 90-day episode of care, following the joint replacement. With that singular payment in mind, it was essential that home health minimize complications and prevent expensive hospital readmissions.

The results have been positive, and not all that surprising to those of us who work in the field. Across all post-acute care settings and areas of the country, Medicare paid approximately $5,000 less when patients were first discharged to home health care compared to other post-acute settings, like skilled nursing or rehabilitation facilities.

Even more promising, thanks to the diligent care provided by home health clinicians, data show the readmission rates for a select group of patients actually dropped under the CJR model. For patients with a major joint replacement without major complication or comorbidity, the average readmission rate is usually eight percent. That group of patients, who received skilled nursing care at home immediately after an acute stay, saw a readmission rate of just five percent. For patients receiving rehabilitation in facility-based settings, the readmission rate was 12 to 15 percent.

Patients vastly prefer to be cared for in their own homes, and as Americans age, the demand is sure to increase for innovative care that can keep them there.

Our success in giving patients what they want, while also giving them the best care possible, depends on our ability to continually fashion programs that meet a variety of needs. That’s why home health care providers have developed initiatives for a variety of different circumstances: in-home care provided after hospitalization, in coordination with primary care providers, and as partners with families to provide home-based long-term care.

While our industry and workforce has shown great innovation and dedication to our vulnerable patients, our ability to add value to the health care system goes beyond our community. In order to truly effect change, home health must play a more central role in the support of Medicare beneficiaries. And for that to happen, payers and providers across the board must embrace home health as the cornerstone to community-based and patient-centered health care models.

Value is difficult concept to measure — while there is no dollar figure to quantify the sense of well-being and dignity that aging or recovering at home brings, we can certainly calculate the savings and efficiency home health care is helping the health care system achieve through innovation and efforts. Our industry is ready, willing and able to meet the health care challenges of an increasing Medicare population, but success is not achieved in a bubble, and the support of the broader health care delivery system is crucial to ensuring all Medicare patients can remain home as long as possible.


Tracey Moorhead is the president and CEO of the Visiting Nurse Associations of America

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