Assessing Home Health Care Quality for Post-Acute and Chronically Ill Patients: Final Report

Home health agencies serve patients with a range of health care needs including those with short-term post-acute needs and the chronically ill with more long-term needs. The purpose of this project was to examine the current approach to public reporting of Medicare home health agency quality with a particular focus on how quality measures perform for the diverse home health population. The results raise the possibility that public reporting is unfair to agencies admitting a relatively large share of patients who tend to have worse outcomes. In particular, agencies with a relatively large share of clinically complex community admissions could be disadvantaged compared to agencies serving a large share of post-acute restorative care patients. Analyses at the agency level, which were outside the scope of this project, are needed to understand the extent and impact of bias in risk-adjusted outcomes at the agency level as well as the relationship among agency and geographic factors, the types of individuals served, and patient outcomes. While many questions remain to be answered, the findings from this project in several areas provide critical information needed by the Department in its efforts to assess and improve the quality of care provided to the diverse home health population. [172 PDF pages]