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The American Journal of Accountable Care March 2019
Safety Net Representation in Federal Payment and Care Delivery Reform Initiatives
J. Mac McCullough, PhD, MPH; Natasha Coult, MS; Michael Genau, MS; Ajay Raikhelkar, MS; Kailey Love, MBA, MS; and William Riley, PhD
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Mark E. Lewis, MPH; and Avery M. Day, MPH
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Carolina dos Santos, BA; Torkom Garabedian, MD; Maria D. Hunt, LPN; Schawan Kunupakaphun, MS; and Pracha Eamranond, MD, MPH
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Improved Cost and Utilization Among Medicare Beneficiaries Dispositioned From the ED to Receive Home Health Care Compared With Inpatient Hospitalization
James Howard, MD; Tyler Kent, BS; Amy R. Stuck, PhD, RN; Christopher Crowley, PhD; and Feng Zeng, PhD
Making Sense of Changes in Healthcare: Lessons From the AcademyHealth National Health Policy Conference
Jaime Rosenberg

Improved Cost and Utilization Among Medicare Beneficiaries Dispositioned From the ED to Receive Home Health Care Compared With Inpatient Hospitalization

James Howard, MD; Tyler Kent, BS; Amy R. Stuck, PhD, RN; Christopher Crowley, PhD; and Feng Zeng, PhD
A retrospective analysis of Medicare claims was used to study emergency department (ED) dispositions, specifically evaluating inpatient admissions compared with home health referrals.
ABSTRACT

Objectives: As the shift from volume to value in healthcare expands, efforts to develop alternatives to hospitalization are gaining momentum. This study explores home health care initiated directly from the emergency department (ED) using the Medicare-reimbursed home health benefit as a potential alternative to hospitalization. We address barriers to home-based care by comparing costs and utilization of care for older adults dispositioned to home health care versus hospital admission.

Study Design: We conducted a retrospective institutional and carrier claims analysis of 5% of total Medicare fee-for-service beneficiaries from January 2012 through December 2013 using 2 cohorts: patients treated in the hospital following an ED visit (inpatient) and patients treated at home following an ED visit (home health). Patients had 1 of the following: congestive heart failure, chronic obstructive pulmonary disease, urinary tract infection, pneumonia, or cellulitis.

Methods: Propensity score–weighted regression was used to measure the total cost of care for 90 days post index visit, hospital admissions/readmissions, and ED revisits.

Results: Total 90-day costs were lower for the home health cohort than for the inpatient cohort ($13,012 vs $20,325; P <.0001). The home health cohort also had lower hospital admissions/readmissions (23.7% vs 33.0%; odds ratio, 1.535; P <.0001) compared with the inpatient cohort. Although the home health cohort had fewer ED revisits, the difference was not statistically significant.

Conclusions: The findings suggest that risk-bearing healthcare organizations could use home-based alternatives to hospital admission as a means of providing high-quality care at a lower cost.

The American Journal of Accountable Care. 2019;7(1):10-16

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