CMS Home Healthcare Policy Reduced Hospital Readmissions

The CMS post-acute care transfer (PACT) policy and the use of home healthcare helped reduce hospital readmissions for recently discharged patients and lower hospital expenditures, according to a study published in the American Journal of Managed Care.

The CMS PACT policy aims to prevent overpayment to hospitals for stays that receive post-acute transfers during discharge. Post-acute transfers include discharges to a skilled nursing facility, hospice, long-term acute care hospital, or a discharge with provider orders for home healthcare within three days of discharge.

Under the policy, hospitals receive reduced payments for shorter-than-average patient stays that fall into certain diagnosis-related groups.

To understand if home healthcare helped improve patient outcomes, researchers looked at patients who experienced discharges to home healthcare under the PACT policy in 2018. They gathered data on Humana Medicare Advantage members from claims submissions, CMS mortality data, enrollment files, primary care contracts, and program participation documents.

The researchers performed an instrumental variable analysis that considered hospital preference for discharge to home healthcare to control for confounding variables and produce the most accurate results.

The study included data from 19,231 patients; 4,160 received discharge to home healthcare, while 15,071 had a discharge to home.

Patients who received home healthcare saw better health outcomes compared to patients who did not, the study showed. Patients in the home healthcare group had a 60 percent smaller risk of readmission after 30 days. Readmission rates were lower for the home healthcare group at the 60- and 90-day marks as well.

Additionally, patients who received home healthcare experienced lower costs compared to patients who had a discharge to home, perhaps due to the reduced rate of hospital readmissions. Hospital spending for the home healthcare group was $239 less per patient, researchers found.

Within the home healthcare group, certain patients experienced better outcomes than others depending on their health condition. Patients in the surgical diagnosis-related group had lower rates of 30-day hospital readmissions compared to patients in the medical diagnosis-related group.

Patients who did not receive Humana at Home—an intensive care management program the payer offers to Medicare Advantage members—and patients ineligible for special needs plans (SNPs) also saw lower 60- and 90-day hospital readmission rates compared to their counterparts in the home healthcare group.

“This study’s findings suggest that policy incentives may be promoting greater value by reducing readmissions while reducing total episode costs,” researchers wrote. “Study results should encourage physicians to consider home healthcare for a broad range of admissions, especially for surgical admissions, that might otherwise result in discharge to home.”

Home healthcare have increased since the start of the coronavirus pandemic, as healthcare stakeholders shifted their routines to ensure care delivery during stay-at-home orders and COVID-19 surges. Payers and providers have leveraged telehealth and remote patient monitoring strategies to help provide home healthcare to patients.

In addition, a number of payers have added home healthcare benefits to their plans to increase access to care for their senior populations.

For example, in March 2021, Anthem announced plans to acquire home healthcare company myNexus, Inc to expand home healthcare services for Medicare Advantage members.

CVS Health’s Aetna partnered Landmark Health in September 2020 to offer home healthcare to Medicare Advantage members with multiple chronic conditions.

Humana and Regence BlueShield also recently partnered with home healthcare providers to increase access to care for members.