title: The impact of home health length of stay and number of skilled nursing visits on hospitalization among Medicare-reimbursed skilled home health beneficiaries.
abstract: The implementation of the Home Health Prospective Payment System in 2000 led to a dramatic reduction in home health length of stay and number of skilled nursing visits among Medicare beneficiaries. While policy leaders have focused on the rising costs of home health care, its potential underutilization, and the relationship between service use and patient outcomes including hospitalization rates have not been rigorously examined. A secondary analysis of five Medicare-owned assessment and claims data sets for the year 2009 was conducted among two independently randomly selected samples of Medicare-reimbursed home health recipients (each n = 31,485) to examine the relationship between home health length of stay or number of skilled nursing visits and hospitalization rates within 90 days of discharge from home health. Patients who had a home health length of stay of at least 22 days or received at least four skilled nursing visits had significantly lower odds of hospitalization than patients with shorter home health stays and fewer skilled nursing visits. Additional study is needed to clarify the best way to structure home health services and determine readiness for discharge to reduce hospitalization among this chronically ill population. In the mean time, the findings of this study suggest that home health providers should consider the benefits of at least four SNV and/or a home health LOS of 22 days or longer.
authors.affiliation: Assistant Professor and Claire M. Fagin Fellow College of Nursing, Villanova University, Driscoll Hall, 800 Lancaster Avenue, Villanova, PA, 19085.
authors.forename: Melissa
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: Research Professor of Nursing, School of Nursing, University of Pennsylvania, Philadelphia, PA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.affiliation: Marian S. Ware Professor in Gerontology, Director of New Courtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Naylor
authors.affiliation: van Ameringen Chair in Nursing Excellence and Professor of Nursing, School of Nursing, University of Pennsylvania, Philadelphia, PA.|Director of the Center for the Integrated Science in Aging, Visiting Nurse Service of New York, New York, NY.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
keywords: Medicare; hospitalization; older adults; propensity score analysis; skilled home health