Cost Of Healthcare Delivery Research Articles

Framework for responsive financing of district hospitals of India.

The current financing of public-sector district hospitals in India relies on historical budget allocations rather than actual utilization or healthcare needs. We utilized empirical data on healthcare delivery costs to develop the financing framework for these hospitals using a blended payment approach. The primary data on cost of delivering services in 27 district hospitals across nine states of India was analysed along with indicators influencing the demand and supply of health services. Payment for outpatient, inpatient, and indirect services was assessed using the risk adjusted global budget, case-based bundled payment, and per-bed-global budget, respectively. Risk adjustment weights were computed by regressing the cost of outpatient care with demand and supply side factors which are likely to influence the utilization or the prices. Budget impact analysis was conducted to assess the fiscal implications of this payment approach, accounting for current care standards and two scenarios: upgrading district hospitals to Indian Public Health Standards (IPHS) or medical colleges. The average annual budget for a district hospital in India is estimated at ₹326 million (US$3.35 million), ranging from ₹66 million to ₹2.57 billion (US$0.8-31.13 million). Inpatient care comprises the largest portion (78%) of the budget. Upgrading to IPHS-compliant secondary hospitals or medical colleges would increase average budgets by 131 and 91.5%, respectively. Implementing a blended payment approach would align funding with healthcare needs, enhance provider performance, and support ongoing financing reforms aimed at strategic purchasing and universal health coverage.

Proactive approaches in congestive heart failure: the significance of early goals of care discussion and palliative care.

Congestive Heart Failure (CHF) poses significant challenges to the healthcare system due to its high rates of morbidity and mortality as well as frequent readmissions. All of these factors contribute to increased healthcare delivery costs. Besides the burden on the healthcare system, CHF has far deeper effects on the patient in terms of psychological burden along with debilitating symptoms of dyspnea, all of which reduce quality of life. Prognostic awareness among patients about their disease along with initiating early goals of care discussion by those involved in the care (physicians, nurses, social worker and patient themselves) can help mitigate these challenges. Adopting a proactive approach to address patient preferences, values and end-of-life goals improves patient-centred care, enhances quality of life and reduces the strain on healthcare resources. In this narrative review, studies have been identified using PubMed search to shed knowledge on what is preventing the initiation of goals of care discussions. Some barriers include lack of knowledge about prognosis in both patients and caregivers, inexperience or discomfort in having those conversations and delaying it until CHF becomes too advanced.

Comparative Analysis of Costing Methods for Magnetic Resonance Imaging in a Tertiary Care Teaching Hospital: An Observational Study

Abstract Background: Health-care costs, often determined through outdated methods, fail to capture the true costs of care delivery. Traditional costing methods in the health-care sector have proven insufficient, leading to potential revenue losses and increased patient out-of-pocket expenses. Activity-based costing (ABC) and time-driven ABC (TDABC) offer alternative approaches to cost calculation, aiming for a more accurate reflection of resource consumption. Methodology: This descriptive observational study was conducted in the magnetic resonance imaging (MRI) center of a tertiary care teaching hospital, focusing on a single noncontrast MRI scan costing. Direct observations and record reviews, including standard operating procedures, policy letters, financial documents, and miscellaneous records, were employed. Results: Using traditional costing, the unit cost of an MRI scan was calculated at INR 1291.51. ABC yielded a unit cost of INR 3613.77, while TDABC resulted in a unit cost of INR 2764.39. A comparison between the three costing methods revealed potential revenue losses with traditional costing. In contrast, TDABC appeared to strike a balance between financial prudence and reduced patient out-of-pocket expenses. Conclusion: The study emphasizes the significance of understanding true costs in health-care delivery. The results advocate for the adoption of TDABC as a favorable compromise, enabling the hospital to retain revenue without burdening patients with additional costs. Notably, the study highlights the necessity for a granular understanding of true costs for successful transitions from volume to value in health care.

Analyzing Health Care Delivery Costs from 2011 to 2020 in the Emergency Departments and Overall Hospital Costs

Analyzing Health Care Delivery Costs from 2011 to 2020 in the Emergency Departments and Overall Hospital Costs

Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings: A Systematic Review.

Background: Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at health care facilities. However, its adoption in health care is not entirely realized due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian health care system, observed at the infrastructural, sociocultural, regulatory, and financial levels, from the perspectives of health care providers, patients, patient caregivers, society, health organizations, and the government. Methods: This review complies with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015. A total of 2,706 peer-reviewed studies published from December 2016 to September 2023 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE, and PsycInfo databases were considered for the title and abstract screening, after which 334 articles were chosen for the full-text review. In the end, 46 studies were selected for data synthesis. Results: Analysis of the literature revealed key barriers such as data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), infrastructure issues, and ICT training gaps. Facilitators included reduced health care delivery costs, enhanced patient access to health care in remote areas, and shorter patient wait times. The real-world experiences of Indian telemedicine practitioners and pioneers are also explored to complement literature-based perspectives on telemedicine implementation. Both stress the need for reliable internet connectivity, technological adoption, comprehensive ICT training, positive sociocultural attitudes, stringent data privacy measures, and viable business models as crucial for effective telemedicine adoption, with experts emphasizing practical adaptability alongside the literature-recognized facilitators.

How to Use Costs in Value-Based Healthcare: Learning from Real-life Examples

BackgroundHealthcare organizations measure costs for business operations but do not routinely incorporate costs in decision-making on the value of care.AimProvide guidance on how to use costs in value-based healthcare (VBHC) delivery at different levels of the healthcare system.Setting and ParticipantsIntegrated practice units (IPUs) for diabetes mellitus (DM) and for acute myocardial infarction (AMI) at the Leiden University Medical Center and a collaboration of seven breast cancer IPUs of the Santeon group, all in the Netherlands.Program Description and EvaluationVBHC aims to optimize care delivery to the patient by understanding how costs relate to outcomes. At the level of shared decision-making between patient and clinician, yearly check-up consultations for DM type I were analyzed for patient-relevant costs. In benchmarking among providers, quantities of cost drivers for breast cancer care were assessed in scorecards. In continuous learning, cost-effectiveness analysis was compared with radar chart analysis to assess the value of telemonitoring in outpatient follow-up.DiscussionCosts vary among providers in healthcare, but also between provider and patient. The joint analysis of outcomes and costs using appropriate methods helps identify and optimize the aspects of care that drive desired outcomes and value.

WITHDRAWN: Reducing healthcare delivery costs using Augmented Reality based Surgical Simulation: A Health Economics Study

WITHDRAWN: Reducing healthcare delivery costs using Augmented Reality based Surgical Simulation: A Health Economics Study

South African physiotherapists' attitudes to medicine prescription as an extension of practice.

The extension of medicine prescription rights to other healthcare providers was proposed to reduce pharmacotherapeutic service delivery challenges in the South African healthcare sector. The scope of practice of physiotherapists is being reviewed to possibly include prescription rights to promote service delivery. Our study assessed the attitudes of registered South African physiotherapists to the inclusion of prescription rights in their scope of practice, including enablers and challenges, and the drug classes they believe to be most relevant. A cross-sectional descriptive survey of South African registered physiotherapists was completed using an online questionnaire. A total of 359 participants completed the questionnaire, where 88.2% agreed that prescribing rights should be introduced, and 87.64% would want to be trained to prescribe. Participants identified several benefits: improved service delivery (91.3%); reduced healthcare delivery costs (89.8%); decreased need for multiple healthcare practitioner consultations (93.2%). Concerns included: inadequate training (55%); increased workload (18.7%); increased insurance premiums against medical liability claims (46.2%). Drugs of relevance included analgesics (95.6%) and bronchodilators (96.0%), while low preference was placed on drugs unrelated to physiotherapy. Chi-square analysis revealed associations between specific drug classes and fields of expertise. South African physiotherapists agree that prescribing and a limited formulary would benefit their scope of practice; however, educational concerns are evident. Findings support the drive to extend the South African physiotherapy scope of practice, however, investigation will be needed to determine the most appropriate way to capacitate future physiotherapists and current graduates should the extension be approved.

To Resuscitate or Not to Resuscitate – The Crossroads of Ethical Decision-Making in Resuscitation in the Emergency Department

Emergency physicians (EPs) working in low-resource settings, where patients mainly bear healthcare delivery, face many challenges. Emergency care is patient-centered and ethical challenges are numerous in situations where patient autonomy and beneficence are fragile. This review discusses some of the common bioethical issues in the resuscitation and post-resuscitation phases of treatment, it proposes solutions and emphasizes the necessity for evidence-based ethics and unanimity on ethical standards. After consensus was reached on the article's structure, smaller groups of authors (2-3) wrote narrative reviews of ethical issues like patient autonomy and honesty, beneficence/nonmaleficence and dignity, justice, and specific practices/circumstances like family presence during resuscitation after having discussions with senior EPs. Ethical dilemmas were discussed, and solutions were proposed. The cases related to medical decision-making by proxies, financial constraints in management, and resuscitation in the face of medical futility have been discussed. Solutions proposed include involving hospital ethics committees early on, having financial mechanisms in place beforehand, and allowing some leverage on a case-to-case basis when care is futile. We recommend developing evidence-based national ethical guidelines and incorporating societal and cultural norms with autonomy, beneficence, non-maleficence, honesty, and justice principles.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Perioperative Medicine: What the Future Can Hold for Anesthesiology.

Community care emergency room use and specialty care leakage from Veterans Health Administration hospitals.

Care leakage from health systems can affect quality and cost of health care delivery. Identifying modifiable predictors of care leakage may help health systems avoid adverse consequences. Out-of-system emergency department (ED) use may be one modifiable cause of care leakage. Our objective was to investigate the relationship between out-of-system ED use and subsequent specialty care leakage. We used the Veterans Health Administration's (VA) Corporate Data Warehouse data from January 2021 to July 2021. A total of 330,547 patients who had at least one ED visit (in-house or community care [CC]) in the index period (January 2021-March 2021) were included. Outcomes were the proportions of specialty care visits in the community within 30, 60, 90, and 120 days from the index ED visit. Instrumental-variables regressions, using VA ED physician capacity as an instrument for Veterans' CC ED use, were utilized to estimate the proportions of subsequent specialty care visits in the community. Estimates were adjusted for patient and facility characteristics. A CC ED visit was associated with increases in the proportions of specialty care visits in the community within 30, 60, 90, and 120 days from index visit. Within 30 days from index visit, CC ED patients were estimated to have a 45-percentage-point (pp; 95% confidence interval [CI], 43-47 pp) higher proportion of CC specialty care visits than patients with an in-house ED visit (p< 0.001). We observed similar, though slightly attenuated, results over long time periods since the index visit. Veterans who have a CC ED visit have a greater proportion of subsequent specialty care visits in CC hospitals and clinics than Veterans with a VA ED visit. This relationship persists when we examine Veterans whose decision to go to a CC ED is influenced by VA ED physician capacity rather than general preferences for CC.

Challenges and opportunities on data protection and privacy in healthcare

The envisage is the next big thing globally is information. It is the wellspring of literally everything and thus the saying ‘’INFORMATION IS POWER’’ Any continent, country, or organization that is considered a superpower is arguably among the best if not the best in handling information. Healthcare is no exclusion on information demands. The best hospitals in the world have practices and a culture of nurturing data/information. Healthcare data is the impetus to improve patient outcomes, predict outbreaks of epidemics, gain valuable insights, avoid preventable diseases, reduce the cost of healthcare delivery and improve the quality of life in general. In Kenya and many developing countries majority of families are a stone’s throw away from poverty if a family member develops. People who do not have access to healthcare are stuck in a vicious circle of poverty and poor health, which can also lead to social instability and migration consequently, health is a prerequisite to prosperity. No country is considered developed without a good health system and the antithetic applies to developing countries. Health management problems are increasing with the growing population, especially with the increasingly larger aging population. Sometimes no response from the hospital for emergencies creates social issues. Similarly, the medical staff in rural areas do not have sufficient resources for treatment and do not have the expertise to diagnose complex diseases. Due to these reasons, people in rural areas focus on big hospitals for proper medical attention, increasing the load on hospitals. The late detection of diseases and severe health problems of older people also complicates the diagnosis process. Therefore, there is a need to provide better medical facilities using an optimized healthcare system that includes body sensors and medical devices to remotely monitor and diagnose medical problems. A country may or may not have a law for user data protection, but the healthcare system should follow the laws of the country to which the user belongs.

A Review of Medical Evacuations Related to Dental Emergencies and Oral-Maxillofacial Injuries.

A literature review was performed to determine the frequency of medical evacuations (MEDEVAC) that are required for dental emergencies (DE) and oral-maxillofacial (OMF) injuries. Fourteen studies were reviewed altogether - eight which quantified evacuation of DEs or OMF injuries in military personnel (from 1982-2013) and six studies that discussed medical evacuation of DEs occurring in civilians working in offshore oil and gas rigs and wilderness expeditions (from 1976-2015). Among military personnel, DE/OMF issues were frequently among one of the top categories of medical evacuations, ranging from 2-16% of all evacuations. Among oil and gas industry workers, 5.3-14.6% of evacuations were dental-related, while one study of wilderness expeditions found that DEs ranked as the third most frequent type of injury that required evacuation. Previous studies have shown that dental and OMF problems often account for one of most frequently cited reasons for evacuation. However, due to the limited study base of DE/OMF medical evacuations, further research is needed to determine their impact on the cost of health care delivery.

Non-prescribed antibiotic dispensing practices for symptoms of urinary tract infection in community pharmacies and accredited drug dispensing outlets in Tanzania: a simulated clients approach

BackgroundAntibiotic dispensing without prescription is a major determinant of the emergence of Antimicrobial Resistance (AMR) which has impact on population health and cost of healthcare delivery. This study used simulated clients describing UTI like symptoms to explore compliance with regulation, variations in dispensing practices and drug recommendation, and quality of seller-client interaction on the basis of the gender of the client and the type of drug outlets in three regions in Tanzania.MethodA total of 672 Accredited Drug Dispensing Outlets (ADDOs) and community pharmacies were visited by mystery clients (MCs). The study was conducted in three regions of Tanzania namely Kilimanjaro (180, 26.79%), Mbeya (169, 25.15%) and Mwanza (323, 48.07%) in March–May 2020. During data collection, information was captured using epicollect5 software before being analyzed using Stata version 13.ResultsOverall, 89.43% (CI: 86.87–91.55%) of drug sellers recommended antibiotics to clients who described UTI like symptoms but held no prescription and 58.93% were willing to sell less than the minimum recommended course. Female clients were more likely than male to be asked if they were taking other medications (27.2% vs 9.8%), or had seen a doctor (27.8% vs 14.7%), and more likely to be advised to consult a doctor (21.6% vs 9.0%); pharmacies addressed these issues more often than ADDOs (17.7% vs 13.2, 23.9% vs 16.6%, 17.7 vs 10.9% respectively). Sellers recommended 32 different drugs to treat the same set of symptoms, only 7 appear in the Tanzanian Standard Treatment Guidelines as recommended for UTI and 30% were 2nd and 3rd line drugs. ADDO sellers recommended 31 drug types (including 2nd and 3rd line) but had permission to stock only 3 (1st line) drugs. The most commonly suggested antibiotics were Azithromycin (35.4%) and ciprofloxacin (20.5%). Azithromycin was suggested more often in pharmacies (40.8%) than in ADDOs (34.4%) and more often to male clients (36.0%) than female (33.1%).ConclusionThese findings support the need for urgent action to ensure existing regulations are adhered to and to promote the continuing professional development of drug sellers at all outlet levels to ensure compliance with regulation, high quality service and better antibiotic stewardship.

Surgical Site Infection after Foot and Ankle Surgery: A Retrospective Analysis of Incidence using a Low Concentration Chlorhexidine Gluconate (CHG) 0.05% in Sterile Water

Category: Other; Ankle; Bunion; Diabetes; Sports; Trauma Introduction/Purpose: Surgical site infection (SSI) after foot and ankle procedures adversely impacts both the quality and cost of health care delivery; increasing hospital length of stay, the number of re-operations, and readmission rate(s). The purpose of the present study was to assess the incidence of SSI in patients who underwent foot and ankle surgery with concurrent intraoperative lavage containing low concentration Chlorhexidine Gluconate (CHG) 0.05% in sterile water. Methods: Seventy-three patients underwent reconstructive foot and ankle procedures which utilized low concentration CHG 0.05% for intraoperative lavage between September 2020 and October 2021, at a single institution. Minimum follow-up for inclusion was at least 90 days; procedures with concurrent use of topical vancomycin powder, or prophylactic antibiotics postoperatively were excluded. Demographic data, and the incidence of complications including postoperative erythema, delayed wound healing, dehiscence, SSI, as well as reoperations were recorded. Univariate and multivariate analyses were performed. Results: Twelve complications occurred in 73 patients (16%): 1 erythema (1.4%), 4 delayed wound healing (5.5%), 1 dehiscence (1.4%), and 6 SSI's (8.2%). Of the 6 SSIs, 2 were superficial and 4 deep; representing an incidence rate of 2.7 and 5.5%, respectfully. Six reoperations were performed in 4 patients for deep SSI; 3 (75%) had a previously documented history of SSI after orthopedic surgery. A history of previous SSI infection after orthopedic surgery was identified as an independent predictor of future SSI following foot and ankle surgery (p &lt;.05). No associations were identified for purported risk factors. Conclusion: The present study is the first to assess the utility of a low concentration CHG 0.05% as an intraoperative irrigation agent for the purpose of mitigating postoperative SSI after foot and ankle surgery. The data suggests a low incidence of deep SSI in patients without a documented history of previous SSI after orthopedic surgery; without the concurrent use of topical vancomycin or prophyaltic antibitiocs, postoperatively. Additional studies are warranted to better understand the potential association identified.

Perioperative oral paracetamol: kicking the intravenous habit to promote sustainable healthcare

Background: The NHS is a significant contributor to the UK’s carbon footprint and has committed to net zero carbon emissions by 2040.1 Oral (p.o.) paracetamol is more sustainable than intravenous (i.v.), producing less waste whilst maintaining analgesic efficacy.2 We proposed that patients presenting for elective surgery should be premedicated with p.o. paracetamol to reduce plastic waste and financial costs. We aimed to develop a quality improvement project to achieve this. Methods: Strategies to assess local attitudes and consider potential impact of paracetamol prescribing changes were initially devised. An online survey was distributed to anaesthetists in the North West of England, and educational material highlighting the environmental benefit and efficacy of p.o. paracetamol disseminated. A local audit was performed to assess i.v. paracetamol use and estimate potential financial savings, with results presented at a local audit meeting for discussion and review. A perioperative paracetamol infographic was produced and distributed on anaesthetic carts and in theatres, with an embedded QR code for continual monitoring of feedback. Results: Our survey of 147 anaesthetists at 12 hospitals demonstrated frequent i.v. paracetamol use, with a willingness to alter prescribing: 91% of respondents reported routine administration of i.v. paracetamol to elective patients, with 67% suggesting intent to change this practice after review of educational material. Local audit data estimated potential annual savings of £7166 with 384 kg less plastic waste for a single local hospital site. The produced infographic (Fig. 13) was rolled out in January 2022. Monitoring of prescribing habits is ongoing. Conclusions: P.O. paracetamol is equally effective as i.v. pre- and postoperatively in patients undergoing many elective surgical procedures; however, current anaesthetic behaviours favour i.v. administration. The switch to p.o. paracetamol would reduce the environmental costs of healthcare delivery, lowering plastic waste and associated carbon emissions. 1.Karliner J, et al. HCCP 2019; Paper 1: 6–482.Mallama M, Valencia A, Rijs K, Rietdijk W, Klimek M, Espana JC. Anaesthesia 2021; 76: 270–6

The next phase in the implementation of value-based healthcare: Adding patient-relevant cost drivers to existing outcome measure sets

ABSTRACT Healthcare expenditure is increasing worldwide and value-based healthcare (VBHC) was introduced as a strategy to improve outcomes and prevent further rises in costs. Monitoring outcomes and costs forms the basis for the implementation of VBHC. Through the efforts already made in the area of outcome monitoring, providers have gained insight into their performance allowing for increasing patient value (PV), defined as patient-relevant outcomes divided by costs of healthcare delivery. However, diminished outcome variation in many benchmarks and the lack of connection between clinical outcomes and costs in clinical practise warrant the debate on the sustainability of current outcome monitoring practises. Cost parameters are currently scarcely incorporated in routine outcome monitoring and adding cost parameters would therefore yield improvement potential of PV. In this viewpoint, we discuss currently used methods for costs calculation within the scope of VBHC and propose a novel, patient-centred and less labour-intensive approach we believe can be used in conjunction with clinical outcome monitoring. That is, the selection of disease/treatment-specific cost drivers and their structural embedment in routine clinical outcome monitoring.

Assessment of Primary Health Care Specialized Reference Clinics in Riyadh First Health Cluster: Outcome, Cost-Effectiveness and Patient Satisfaction.

PurposeThe objectives of the study are to assess the outcome and cost-effectiveness of specialized reference clinics (SRCs) in primary health care centers (PHCCs) of Riyadh First Health Cluster (RFHC), then to estimate the patient satisfaction among clients utilizing such SRCs.Patients and MethodsThis facility-based study was conducted in Riyadh city, Saudi Arabia among six PHCCs in RFHC that contain SRCs. Records of all patients utilizing SRCs and their referral information were studied along two years. An in-depth interview was conducted with health care providers in SRCs. Cost analysis was calculated by the financial support group within RFHC. Also, a randomly selected 400 subjects utilizing SRCs were asked to fill patient satisfaction questionnaire.ResultsOver two years, a total number of 55,084 patients utilized SRCs among different specialties. Most of these patients (86.7%) had full medical service within PHC-SRCs with no need for referral to hospitals. SRCs are significantly effective in decreasing the burden on hospitals in most specialties (p < 0.001). This effectiveness is significantly increased during the 2nd year of service. The time spent until appointment is significantly reduced from an average of six weeks in hospitals to an average of one week in SRCs. SRCs are very cost-effective as they reduced referrals to hospitals by 86.7% among 55,084 patients who utilized SRCs over two years, saving total costs of about 14.08 million Saudi Riyals (3.75 million US dollars). Most of the specialties are cost-effective except for urology and general surgery clinics, which are not cost-effective. Patient satisfaction is high regarding all service domains. The overall patient satisfaction score increased from 71.4% in the 1st year up to 73.2% in the second year.ConclusionPHC-SRCs are cost-effective health services and their creation is reasonable and beneficial in terms of reducing costs of health care delivery, reducing the burden on hospitals, and improving patient satisfaction.

The Cost of Ambulatory Breast Reduction: Hospital Reimbursement Versus Surgeon Payments.

Introduction: Reduction mammoplasty (RM) is one of the most common operations performed in plastic surgery. While US national surgical expenditures have risen in recent years, studies have reported decreasing reimbursement rates for plastic surgeons. The purpose of this study is to characterize the trends in charges and payments for a common plastic surgery operation, ambulatory RM, for facilities and physicians. Methods: A Medicare patient records database was used to capture hospital, surgeon, and anesthesiologist charges and payments for ambulatory RM from 2005 to 2014. Values were adjusted for inflation. A ratio of hospital to surgeon charges and payments were calculated: charge multiplier (CM) and payment multiplier (PM), respectively. Charges, payments, Charlson comorbidity index, CM, and PM values were analyzed for trends. Results: This study included 1001 patients. During the study period, the facility charge for RM per patient increased from $8477 to $11,102 (31% increase; p < .0005), and the surgeon charge increased from $7088 to $7199 (2% increase; p = .0009). Facility payments increased from $3661 to $3930 (7% increase; p < .0005), and surgeon payments decreased from $1178 to $1002 (15% decrease; p < .0005). CM increased from 1.2 to 1.54, and PM increased from 3.11 to 3.92. Conclusions: Charges and payments to facilities for ambulatory RM increased disproportionately to that of surgeons, likely due in part to rising administrative costs in health care delivery. This may disincentivize plastic surgeons from offering RM at hospital-based surgical centers, limiting patient access to this operation.

Patient cognitive impairment associated with higher home health care delivery costs.

To assess whether home health agencies incur significantly higher care delivery costs for patients with cognitive impairment across three timeframes relevant to home health payment policy. Linked Medicare home health claims and patient assessments, National Health and Aging Trends Study (NHATS), and home health agency cost reports for a nationally representative sample of Medicare beneficiaries receiving home health between 2011 and 2016. We modeled care delivery costs incurred by the home health agency as a function of patient cognitive impairment using multivariable, propensity score-adjusted, generalized linear models. We identified NHATS participants who experienced an index home health episode between 2011 and 2016 (n=1214; weighted n = 5,856,333) and linked their NHATS survey data to standardized patient assessment and claims data for the episode, as well as cost report data for the home health agency that provided care. Across the first 30, 60, and 120 days of caring for a patient with cognitive impairment, we estimate additional costs of care to the home health agency of $186.19 (p=0.02), $282.46 (p=0.01), and $740.91 (p=0.04), respectively. Home health agencies incur significantly higher costs when caring for a patient with cognitive impairment. As patient cognitive function is not considered in the most recent Medicare home health reimbursement model, agencies may be disincentivized from providing care to those with cognitive impairment. Policy makers and researchers should carefully monitor home health access among Medicare beneficiaries with cognitive impairment and further investigate the inclusion of patient cognitive function in future risk adjustment models.