Value-based care through postacute home health under CMS PACT regulations

Area of Science:

• Health Services Research
• Health Economics
• Geriatric Medicine

Background:

• Medicare Advantage (MA) plans face scrutiny regarding postacute care transitions.
• The Centers for Medicare & Medicaid Services (CMS) Post-Acute Care Transfer (PACT) regulations influence discharge decisions.
• Previous research on home health discharge outcomes has yielded conflicting results.

Purpose of the Study:

• To evaluate the association of discharge to home health versus home with patient outcomes and expenditures in MA.
• To determine if the impact of home health discharge varies across different patient subpopulations.

Main Methods:

• Retrospective cohort study utilizing Medicare Advantage claims data.
• Instrumental variable (IV) analysis employed to mitigate confounding factors.
• Hospital-level probability of home health discharge served as the instrumental variable.

Main Results:

• Patients discharged to home health showed a 60% lower 30-day and 37% lower 90-day readmission rate compared to home discharge.
• Total expenditures were 11% lower for patients discharged to home health.
• Subgroup analyses revealed variations in outcomes based on diagnosis-related groups and post-discharge care intensity.

Conclusions:

• PACT regulations may enhance healthcare value by reducing readmissions and costs for select patients.
• Findings contrast with prior studies, likely due to improved methodology controlling for unmeasured confounders.
• Home health discharge appears beneficial for specific Medicare Advantage populations, challenging previous assumptions.