For years, we have been wanting hard data to lay at the feet of MedPAC and CMS, Anthem and UnitedHealth, to show what we have always known. Healthcare at Home saves more than it costs. When in-home care follows -- or precedes -- a hospital stay, hospital costs decrease at a rate that dwarfs the cost of the in-home care.
Finally, an unimpeachable researcher studied a statistically significant group, controlled it for covariates, and compared it to a control group. The findings: patients who receive home health care after a hospital discharge save the system about $6,500 over the course of a year. Plus, home health care "independently decreased the hazard of follow-up readmission and death."
The study, titled "Impact of Home Health Care on Healthcare Resource Utilization Following Hospital Discharge: a Cohort Study," was conducted by the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University from January 1, 2013 until June 30, 2015 and will be published in the American Journal of Medicine in the near future.
Methodology and results
The study looked at 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.* Home health care also resulted in noticeable decreases in follow-up readmissions and death. Patients discharged from the Digestive Disease, Heart & Vascular, Medicine, Neurological, and Urology & Kidney Institutes benefited most from home health care.
"(W)e observed significant financial and clinical benefits associated with hospital discharge to home with home health care relative to discharge home with 'self-care,'" concluded the authors of the study.1
The study concluded that "home health care can improve continuity of care while decreasing overall costs" and that "home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge."
National Association for Home Care and Hospice interim president Bill Dombi welcomed the results. In a report on the study published on the NAHC web site, he said, "This important study clearly demonstrates that home health care has significant dynamic value in controlling care costs and achieving better patient outcomes. The study proves that a strong investment in the expanded use of home health care by Medicare, Medicaid and other payment programs would save billions in unnecessary health care spending."
The entire 107-page Cleveland Clinic report can be found in draft form via the link in footnote 1, below. For convenience, we reprint the authors' abstract here.
As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population.
A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 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. Multi-variable linear and Cox proportional hazards regression were used to adjust for covariates.
Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p<0.0001). Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p<0.0001) and death (HR 0.80, p<0.0001). Subgroup analyses revealed that home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p<0.01), Heart & Vascular (adjusted savings of $11,453, p<0.0001), Medicine (readmission HR 0.71, p<0.0001), Neurological (readmission HR 0.67, p<0.0001), and Urology & Kidney (emergency department encounter HR 0.75, p=0.02) Institutes.
Discharge with home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans.
*In statistics, a covariate is a variable that is possibly predictive of the outcome under study. A covariate may be of direct interest or it may be a confounding or interacting variable. The alternative terms explanatory variable, independent variable, or predictor, are used in a regression analysis.
1 Roy Xiao, Jacob A. Miller, William J. Zafirau, Eiran Z. Gorodeski, James B. Young, "Impact of Home Health Care on Healthcare Resource Utilization Following Hospital Discharge: a Cohort Study, The American Journal of Medicine (2017)"
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org