Home Health Agency Performance in the United States: 2011-15

Abstract

Objectives: To evaluate home health agency quality performance.

Design: Observational study.

Setting: Home health agencies.

Participants: All Medicare-certified agencies with at least 6 months of data from 2011 to 2015.

Measurements: Twenty-two quality indicators, five patient survey indicators, and their composite scores.

Results: The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011-12 to 2014-15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores.

Conclusion: Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care.

Keywords: geographic variation; health services; home health agency; home health care; quality measurement.

Figure 1

(A) Distribution of home health agency performance and (B) coefficient of dispersion according to the 27 individual indicators: 1 = how often patients improved at getting in and out of bed; 2 = how often patients improved at walking or moving around; 3 = how often patients improved at bathing; 4 = how often patients’ breathing improved; 5 = how often patients had less pain when moving around; 6 = how often the home health team treated symptoms of people with heart failure (weakening of the heart); 7 = how often the home health team treated their patients’ pain; 8 = how often the home health team checked patients for pain; 9 = how often patients improved at taking their drugs correctly by mouth; 10 = how often the home health team determined whether their patients received a pneumococcal vaccine (pneumonia shot); 11 = how often the home health team determined whether patients received an influenza shot for the current influenza season; 12 = how often the home health team began their patients’ care in a timely manner; 13 = how often the home health team taught patients (or their family care-givers) about their drugs; 14 = for patients with diabetes, how often the home health team obtained doctor’s orders, gave foot care, and taught patients about foot care; 15 = how often the home health team checked patients for depression; 16 = how often the home health team checked patients’ risk of falling; 17 = how often home health patients had to be admitted to the hospital; 18 = how often patients receiving home health care needed any urgent, unplanned care in the hospital emergency department without being admitted to the hospital; 19 = how often patients’ wounds improved or healed after an operation; 20 = how often the home health team took doctor-ordered action to prevent pressure sores (bed sores); 21 = how often the home health team included treatments to prevent pressure sores (bed sores) in the plan of care; 22 = how often the home health team checked patients for risk of developing pressure sores (bed sores); 23 = patients who reported that they would definitely recommend the home health agency to friends and family; 24 = patients who reported that their home health team discussed medicines, pain, and home safety with them; 25 = patients who gave their home health agency a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest); 26 = patients who reported that their home health team communicated well with them; 27 = patients who reported that their home health team gave care in a professional way.

Figure 2

Distributions of home health agency composite performance score at the agency level. (A) Overall difference in scores between 2011–12 and 2014–15; (B) percentage of agencies classified in the low-performance group; (C) difference in scores between agencies in never being in; one, two, or three times being in, and all times being in the low-performance group.

Figure 3

Geographic variation in (A) home health care performance according to U.S. county in 2011–12, (B) 2014–15 performance based on the 2011–12 performance scale, (C) 2014–15 performance based on its own scale, and (D) locations of agencies in the low-performance group throughout the study period. Performance was mapped by shading counties with a gradient from red to green (lowest rate in red to highest rate in green).