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

To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations.

Claims-based retrospective cohort study.

Instrumental variable (IV) analysis, with prior hospital-level probability of discharge to home health as the IV, to control for unobservable as well as observable confounders.

Compared with 15,071 patients discharged to home, 4160 patients discharged to and receiving timely home health services were 60% less likely to be readmitted within 30 days and 37% less likely at 90 days. Total expenditures from time of admission to 90 days post discharge were 11% lower in the home health group. The association of discharge to home health with reduced readmission and reduced costs varied by subpopulations defined by surgical vs medical diagnosis-related group and receipt of intensive care management following discharge.

The PACT policy may be promoting greater value by reducing readmissions while lowering total expenditures for patients who do not require intensive postacute care. Findings were in contrast to those of previous studies, in which discharge to home health has been associated with higher rates of readmission. Earlier studies did not control for unmeasurable confounders, involved narrowly defined populations, and used older data.