Despite providers often touting their success in keeping older adults at home and out of the hospital, average readmission rates for the home health industry remained relatively flat from 2017 to 2018.

That’s according to the latest Home Health Chartbook, a comprehensive analysis of the post-acute care industry and home health sub-sector compiled by Avalere Health for the Alliance for Home Health Quality and Innovation. The 2019 Chartbook was released on Thursday.

In 2018, the average 30-day home health readmission rate across all MS-DRGs checked in at 17.50%, according to the Chartbook. The 2017 mark was 17.15%.

Also of note: The 30-day readmission rate across all MS-DRGs was also exactly 17.50% for skilled nursing, compared to a 2017 mark of 17.41%.

The annual Chartbook from Avalere and the Alliance for Home Health Quality and Innovation compiles data from a variety of sources, including the Centers for Medicare & Medicaid Services’ (CMS’s) Home Health Compare website.

While readmission rates stayed flat from 2017 to 2018, provider quality improved across several categories.

Across nine quality domains tracked on Home Health Compare, national averages for patient outcomes improved for six and stayed the same for three. The greatest improvement came in the “got better at getting in and out of bed” measure, which ticked up from 68% in 2017 to 74% in 2018.

Demographic breakdown

From a demographics perspective, home health patients are more likely to be older, sicker and poorer compared to their broader Medicare peers.

Indeed, more than half of home health patients in 2016 had annual incomes of less than $25,000, while about 46% of patients had five or more chronic conditions. In the overall Medicare population, less than 23% of patients had five or more chronic conditions in 2016, according to the Chartbook.

“I think the Chartbook continues to paint a picture that we already know in home health — that patients are more vulnerable, older, sicker, poorer and a more racially diverse patient population,” Jennifer Schiller, the Alliance’s director of policy communications and research, told Home Health Care News. “And it’s a population with needs that go across a spectrum.”

Additionally, home health patients are more likely to have two or more activities of daily living (ADL) limitations.

Severe mental illness is also more prevalent in the home health population compared to the group of all Medicare beneficiaries. Of the home health patients living with a severe mental illness in 2016, about 95% suffered from depression, suggesting a continued need for access to behavioral health services in the space.

The 2019 Chartbook was consistent with years past, though some things did stand out, Schiller said.

That includes the specific clinical profile of home health patients.

For example, the most common MS-DRG for Medicare beneficiaries discharged from a hospital to Part A home health episodes in 2018 was “septicemia or severe sepsis without mechanical ventilation for more than 96 hours.”

“For many, many years, the top MS-DRG in home health has been ‘major joint replacement without major complications or co-morbidities,’” Schiller said. “It’s been the standard-bearer. It has been the thing that home health does.”

Where patients are coming from

Under the Patient-Driven Groupings Model (PDGM), home health reimbursement will generally be higher for patients coming from institutional settings compared to those coming from the community.

Critics of the model argue the move will encourage providers to shy away from community-based referrals, putting a big chunk of Medicare beneficiaries at risk.

In 2018, about 55% of the patients home health providers served came into their services from community settings, according to the Chartbook.

Just 28% of patients came from short-stay hospitals prior to their home health episode beginning.

While most home health patients came from one of those settings in 2018, a decent percentage also came from skilled nursing facilities (SNFs). Slightly less than 12% of home health episodes were preceded by a SNF stay.

Hardly any home health patients came from long-term care hospitals in 2018.

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