Home care utilization by congestive heart failure patients: a pilot study

Home health care costs have increased more than any other health care service covered by Medicare, and new methods of payment by Medicare are being introduced. A prospective payment system would replace the per visit rate now paid to home care agencies by Medicare. In order to remain viable under a new payment system, home health care agencies will need to be efficient in the delivery of home care services and still demonstrate effective patient care. The intent of this descriptive study was to determine norms of resource utilization for the congestive heart failure (CHF) patients admitted and discharged from a not-for-profit home health agency (HHA). Forty agency records were retrospectively reviewed using the Resource Utilization Inventory to collect the characteristics and resource utilization of the sample group. The CHF patients were older than most home care clients and had chronic health problems. Because of these chronic health problems, over half of the study population had caregivers so that the clients could remain in their own homes. Most clients clearly demonstrated the need for skilled nursing or home health aide visits after being hospitalized for an acute CHF episode. Less than half of the study group were discharged form the HHA as improved, and frequently were discharged to another healthcare facility. These results provide a beginning direction for profiling the CHF patient's consumption of resources for setting prospective reimbursement rates.