TrendLens December 21, 2017: Study Shows Home Health Saves Healthcare Costs And Readmissions

Lisa Remington

Welcome to TrendLens…trends bending the curve in home health and post-acute care. In this issue of TrendLens, we discuss an important study of how home health is saving healthcare costs and limiting readmissions. Previous to this study, no other study has investigated how home health care has saved costs in context to a large diverse patient population.

Lisa Remington, President, Remington Health Strategy Group

Patients who receive home health care after a hospital discharge save $6,433 in healthcare costs over the course of a year, and home health care “independently decreased the hazard of follow-up readmission and death,” according to a new study published in the online American Journal of Medicine.

The study included 64,541 patients, with 11,266 control patients matched to 6,363 home health care patients across 11 disease-based institutes. During the 365-day post-discharge period, home health care resulted in unadjusted savings of $15,233, or $6,433 after adjusting for covariates.

The retrospective cohort study was conducted January 1, 2013-June 30, 2015 at a single tertiary care institution to assess healthcare utilization and costs after discharge with home health care. Control patients discharged home with “self-care” were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up emergency department encounter, readmission, and death.

“These data inform development of value-based care plans."

Subgroup analyses was also conducted. “Patients discharged from the Digestive Disease, Heart & Vascular, Medicine, Neurological, and Urology & Kidney Institutes benefitted most from home health care,” was the finding here.

The study was conducted by researchers at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and reported in the official journal of the Alliance for Academic Internal Medicine.

“We observed significant financial and clinical benefits associated with hospital discharge to home with home health care relative to discharge home with ‘self-care,’” the study concludes. “As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge.”

“Discharge with home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death.” Previously, “no studies have investigated the utility of home health care within the context of a large and diverse patient population.”

“These data inform development of value-based care plans.”

Patients After SNF Discharges

This current study complements one published in October demonstrating the value of home health following a Skilled Nursing Facility (SNF) discharge: “Transitions From Skilled Nursing Facility to Home: The Relationship of Early Outpatient Care to Hospital Readmission.”

Patients discharged from a SNF to home following a hospital stay experienced significantly different outcomes depending on whether the patient had a home health visit within a week of discharge (the key being within a week). Home health “is associated with reduced hazard of 30-day hospital readmissions.”

The study was reported in the October 2017 issue of The Journal of Post-Acute and Long-Term Care Medicine. Researchers were led by Jennifer L. Carnahan, MD, MPH, Assistant Professor of Medicine at Indiana University Center for Aging Research, Regenstrief Institute, Inc. For those who had a home health visit within a week of SNF discharge, the data shows “almost a 40% decreased hazard of hospital readmission,” according to Dr. Carnahan.

A Special Report on this study was featured in the September/October issue (pages 10-13) of the Remington Report magazine.

By: Ronald M. Schwartz, Writer, The Remington Report