Home Health Care Reduces Hospitalization and Readmissions
The introduction of the Affordable Care Act’s (ACA) Hospital Readmission and Reduction Program (HRRP) reflects the paradox of the U.S. healthcare system and the need for value-based care strategies such as Home Health partnerships. This has been paramount in finding that Home Health care reduces hospitalization and readmissions.
Since the 1950s, the U.S. government and healthcare leadership have burgeoned the system through funding basic and applied research and academic medical centers (Young and Kroth 2018, 372). The surfeit of tertiary (perhaps even quaternary) care enabled the United States to do an excellent job of delivering care and treatment in the hospital. However, the overgrowth of specialized physicians and technology has incapacitated the healthcare delivery system to keep people out of the hospital (Young and Kroth 2018, 9). This absence also created health disparities.
Medicare, Reimbursement Models, and the Hospital Readmission Reduction Program
High levels of readmissions after a hospital stay reflect low quality and non-continuity within U.S. healthcare production. Past and current data indicate that readmissions are prevalent under fee-for-service reimbursement models (Young and Kroth 2018, 99). This reimbursement design does not encourage healthcare providers to plan how to keep patients from being readmitted (LaPointe 2021). Fee-for-service reimbursement also does not encourage collaboration between hospitalists, primary care providers, pharmacists, and allied health professionals, especially in the discharge planning process. The Medicare program exposed the fragmentation as this population requires more hospitalizations than others (LaPointe 2021).
Medicare–a government-subsidized health insurance program for individuals aged sixty-five or older or persons with disabilities–covers hospital stays for beneficiaries under the Part A Hospital Trust Fund. Before the ACA, twenty percent of all Medicare fee-for-service payments went to unplanned readmissions totaling seventeen billion dollars annually (Young and Kroth 2018, 99). As a response, the Obama administration created the HRRP. (The ACA was not only in response to millions of Americans being uninsured but also to the “lack of guaranteed basic level of care and quality of care”) (Kroth and Young 2018, 372).
The value-based rectification began scrutinizing discharges in 2012 (Kroth and Young 2018, 99). The legislation dictates that the Centers of Medicare and Medicaid Services (CMS) reduce payments to hospitals when Medicare patients who have been diagnosed or have been treated for acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, coronary artery bypass graft (CABG) surgery, elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA) are readmitted within thirty days of discharge (“Hospital Readmissions Reduction Program” 2021).
The intention of the ACAs HRRP is to protect healthcare consumers as well as preserve the nation’s funding for Medicare beneficiaries through value-based reforms. The startling amount of Medicare reimbursement monies that go to readmissions make some experts fearful for the longevity of the Medicare Part A program. The 2020 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds indicated that the Part A fund is running dry (“The 2020 Annual Report Of The Boards Of The Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds” 2021). Waste, such as preventable re-hospitalizations, plays a big part in the problem. CMS reporting in 2019 indicates that the HRRP implementation is not enough to prevent readmissions. Eighty-three percent of the 3,129 hospitals that were part of the program received a penalty. Experts estimated that the penalties cost the 2,583 hospitals 563 million dollars (Rau 2021).
Home Health Partnerships as a Post-Acute Care Strategy
Home Health partnerships offer an array of benefits, including patient-centered care and communication. As a strategy for reducing waste, a Home Health partnership can decrease preventable emergency department and in-patient visits in addition to the delivery of high-touch patient support.
Home care strategies add value to care for organizations and providers that take on high-risk populations that also experience high rates of readmissions. Medicare, Medicaid, and dual-eligible populations are prime examples. Common goals of these strategies are to keep individuals within these populations healthy, divert emergency department visits and hospital readmissions as well as improve their overall quality of life. Telehealth can only go so far in terms of the care that takes place in a doctor’s office. The eyes and ears of a home health medical professional streamlines care coordination—a critical component of value-added care for high-risk populations—which ultimately prevents acute conditions that warrant ED or in-patient care.
Organizations have lowered ED visits up to 70% through home health partnerships. As part of an overall strategy to stabilize (in particular) vulnerable patients, a Home Health partnership can improve patient satisfaction, medication and therapy compliance, and post-discharge outcomes—ultimately reducing hospital readmissions. Learn more about the other benefits of a Home Health partnership for your organization and patients.
“Hospital Readmissions Reduction Program”. 2021. Centers Of Medicare And Medicaid Services.
LaPointe, Jacqueline. 2021. “3 Strategies To Reduce Hospital Readmission Rates, Costs”. Revcycleintelligence.
Rau, Jordan. 2021. “New Round Of Medicare Readmission Penalties Hits 2,583 Hospitals”. Kaiser Health News.
“The 2020 Annual Report Of The Boards Of The Trustees Of The Federal Hospital Insurance And Federal Supplementary Medical Insurance Trust Funds”. 2021. Washington DC: The Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.
Young, Kristina M, and Philip J Kroth. 2018. Sultz & Young’s Health Care USA. 9th ed. Burlington: Jones and Bartlett Learning, LLC.