Unfulfilled home health referrals lead to higher mortality among Medicare Advantage members.

Abstract

Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system-related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not. Retrospective quasi-experimental study. Following acute hospitalization, members with discharge orders to receive home health services between January 2021 and October 2022 were identified in a medical claims database consisting of MA beneficiaries. Members who received services within 30days of discharge were balanced using inverse propensity score weighting on member- and admission-related covariates with a comparator group of members who did not receive services. Primary outcomes included mortality and readmissions in the ensuing 30, 90, and 180 days. Secondary outcomes included emergency department visits, primary care visits, and per-member per-month costs. The home health-treated group consisted of 2115 discharges, and the untreated group consisted of 761discharges. The treated group experienced lower mortality at 30 days (2% vs 3%, respectively; OR, 0.58; 95%CI, 0.36-0.92), 90 days (8% vs 10%; OR, 0.77; 95% CI, 0.60-0.98), and 180 days (11% vs 14%; OR, 0.81; 95%CI, 0.65-0.99). The treated group also experienced higher readmissions at 30 days (13% vs 10%; OR, 1.26; 95% CI, 1.01-1.60), 90 days (24% vs 16%; OR, 1.69; 95% CI, 1.39-2.05), and 180 days (33% vs 24%; OR, 1.52; 95% CI, 1.29-1.79). MA members referred to home health after acute hospitalization who did not receive home health services had higher mortality.