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. 2022 Feb;79(1):90-101.
doi: 10.1177/1077558720974528. Epub 2020 Nov 24.

Home Health Care Quality, Its Costs and Implications for Home Health Value-Based Purchasing

Dana B Mukamel  1 , Heather Ladd  1 , Eugene Nuccio  2 , Jacqueline S Zinn  3 , Dara H Sorkin  1 , Susan L Ettner  4
Affiliations

Home Health Care Quality, Its Costs and Implications for Home Health Value-Based Purchasing

Dana B Mukamel et al. Med Care Res Rev. 2022 Feb.

Abstract

The Home Health Value-based Purchasing (HHVBP) demonstration, incorporating a payment formula designed to incentivize both high-quality care and quality improvement, is expected to become a national program after 2022, when the demonstration ends. This study investigated the relationship between costs and several quality dimensions, to inform HHVBP policy. Using Medicare cost reports, OASIS and Home Health Compare data for 7,673 home health agencies nationally, we estimated cost functions with instrumental variables for quality. The estimated net marginal costs varied by composite quality measure, baseline quality, and agency size. For four of the five composite quality measures, the net marginal cost was negative for low-quality agencies, suggesting that quality improvement was cost saving for this agency type. As the magnitude of the net marginal cost is commensurate with the payment incentive planned for HHVBP, it should be considered when designing the incentives for HHVBP, to maximize their effectiveness.

Keywords: costs; home health agencies; incentives; quality measures; value-based purchasing.

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Figures

Figure 1:
Figure 1:
Net Marginal Cost for a 1 Unit Increase as the SQM increases from Baseline for Agencies at the 25th, 50th and 75th Percentiles of the Total Cost Distribution (Source: Author’s contribution)
See this image and copyright information in PMC

References

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