The effects of cost-containment on home health agencies.

Home health agencies are examined in terms of changes their organizations have experienced as a result of federal health care cost-containment policies. Contrasts are made between data collected from a sample of home health agencies in 1983 and 1984. Some attention is also given to differences in home health agency experiences by state. Home health agencies are beginning to change their tax status to for-profit and to try to attract private insurance clients which may potentially alter the home health market in favor of younger clients. The agencies experienced many more denial of claims by the Medicare fiscal intermediaries in 1984 than in 1983.     

Financing and home health agencies.

Home health agencies are examined with reference to changes that have occurred in their financing as a result of DRGs. Comparisons are made based on organizational affiliation and findings indicate agencies that become affiliated with larger and more complex organizations are more frequently proprietary agencies. In other ways, however, nonprofit and proprietary agencies are becoming more similar. Both types of agencies are increasingly interested in reducing reliance on government funding.     

Understanding hospital referrals to home health agencies

Using resource dependency theory and transaction-cost economics theory, we examined the simultaneous effects of a vertical integration strategy and environmental complexity on home health agency (HHA) referrals by hospitals. Discharge data for calendar year 1990 from 61 Pennsylvania hospitals were analyzed. Using hospital ownership of home health agencies and urban versus rural location as the primary independent variables, a logistic regression model calculated the probability of HHA referral, after controlling for long-term care beds and patient characteristics. Results showed that HHA ownership was a significant predictor of home health referrals for both rural and urban hospitals, although the effect was greater for urban hospitals. These results suggest that hospitals are actively using referrals to home healthcare in response to environmental pressures. As these pressures increase, hospitals will benefit from tight linkages with home health providers.     

A comparative analysis of agencies providing home health services.

This study analyzed hospital-based and community-based home health care agencies by means of a small purposive comparative case analysis. The results revealed that hospital-based agencies were different from community-based agencies in terms of agency organization, management, personnel, revenues and expenditures. The voluntary community-based agencies examined were free-standing, single purpose agencies providing the lion's share of direct services to the home health care population. The hospital-based agencies (and public community-based agencies) examined were components of larger organizational structures. Hospital-based agencies concentrate their activities on case finding, case management, and the coordination of patient services, as well as the direct provision of medical therapy and social services. The type of home health agency, community-based or hospital-based, or those examined has been found to define this agency's primary function. This also determined its personnel/staffing pattern and consequently, to a large extent, its expenditure pattern. Additionally, most revenues for certified home health agencies are derived from cost-based reimbursement methodologies of public funding sources. Therefore, agency surpluses or shortages are primarily associated with personnel expenditures and therefore with agency mission and agency type. This study concludes with a discussion of some trends and events that are likely to affect the home health care agencies of the future.     

Hospice: staffing and cost implications for home health agencies

The authors describe a study done to evaluate the implementation of a home health agency-based hospice program. Forty-one hospice patients were compared with a group of terminally ill patients receiving standard home care treatment. The differences in the type, frequency, and intensity of services required by the two groups were evaluated. While hospice care was found to be slightly more staff intensive than standard home care treatment, the differences were minimal. The results suggest that a home health agency with a multidisciplinary staff could implement a hospice program without making dramatic organizational, administrative, or resource change.     

Adverse drug reaction monitoring in Mississippi home health care agencies

A statewide survey of home health care agency directors in Mississippi was conducted to determine the extent of Adverse Drug Reaction (ADR) monitoring and reporting by health care professionals. A 24-item questionnaire was sent to agency directors eliciting responses on agency characteristics, rate of occurrence of ADRs, and attitudes toward responsibility for monitoring ADRs. A total of 77 questionnaires were returned yielding a response rate of 48%. The average program enrolled 104 patients with 3.5 ADRs reported by health care professionals per year (range 0-65). Agency directors reported that physicians, nurses, pharmacists, and members of the pharmacy and therapeutics committee should monitor ADRs. Results indicated a need for all health-care professional involved in home health care to increase their ADR monitoring and reporting activities.     

Public policy and current effect on home health agencies.

Home health agencies have experienced increases in funding, personnel and clientele primarily as a result of changes in federal policy which liberalizes Medicare reimbursement for home health services. These agencies are noticing an increase in elderly clientele, particularly in the 75 years and older category, and have noted that they are seeing a sicker clientele as hospitals discharge patients earlier. Those home health agencies that offer other services, however, have experienced reductions where funding is from sources other than Medicare. There is a growing reluctance on the part of home health agencies to accept Medicaid patients due to low rates of reimbursement. This raises concern for access to service for the low income population, particularly low income elderly.     

The poverty of information systems management in home health agencies: implications for survivability

Home health agencies are increasingly being challenged to cope with economic, financial and clinical pressures. This study examines the extent to which home health agencies have cultivated their information systems as an aid for managing performance and external forces. Colorado and New Mexico home health agencies participated in the research project. The findings indicate that only modest investments have been made by respondents in their information systems. The typical respondent reports a personal computer-based system which addresses some financial reporting data, but which does not emphasize care delivery or contextual factors. The implications of these findings for the survivability of home health agencies are discussed.     

The poverty of information systems management in home health agencies: implications for survivability

Home health agencies are increasingly being challenged to cope with economic, financial and clinical pressures. This study examines the extent to which home health agencies have cultivated their information systems as an aid for managing performance and external forces. Colorado and New Mexico home health agencies participated in the research project. The findings indicate that only modest investments have been made by respondents in their information systems. The typical respondent reports a personal computer-based system which addresses some financial reporting data, but which does not emphasize care delivery or contextual factors. The implications of these findings for the survivability of home health agencies are discussed.     

Profit status of home health care agencies and the risk of hospitalization

We examined the association of profit status and patient hospitalizations in the present-day home health care market, a market that grew substantially in the past decade, with much of that growth attributed to the entry of for-profit agencies. Data from the 2007 National Home and Hospice Care Survey were linked to the risk-adjusted agency-level measure of the percent of home health episodes of care ending in hospitalizations available from the Centers for Medicare and Medicaid Services' (CMS) Home Health Compare Web site. A linear regression model was estimated (n?=?510). Control variables included other agency characteristics besides profit status, area hospital bed supply, and state dummy variables to control for state fixed effects. For-profit agencies were more likely than not-for-profit agencies to have a risk of hospitalizations greater than expected after accounting for patient characteristics and model control variables. Attributes of the CMS hospitalization measure are discussed and implications for future research described.     

Advance directives in home health and hospice agencies: United States, 2007

This report provides nationally representative data on policies, storage, and implementation of advance directives (ADs) in home health and hospice (HHH) agencies in the United States using the National Home and Hospice Care Survey. Federally mandated ADs policies were followed in >93% of all agencies. Nearly all agencies stored ADs in a file at the agency, but only half stored them at the patient's residence. Nearly all agencies informed staff about the AD, but only 77% and 72% of home health agencies informed the attending physician and next-of-kin, respectively. Home health and hospice agencies are nearly universally compliant with ADs policies that are required in order to receive Medicare and Medicaid payments, but have much lower rates of adoption of ADs policies beyond federally mandated minimums.