scholarly journals Continuity in the Provider of Home-Based Physical Therapy Services and Its Implications for Outcomes of Patients

2012 ◽  
Vol 92 (2) ◽  
pp. 227-235 ◽  
Author(s):  
David Russell ◽  
Robert J. Rosati ◽  
Evie Andreopoulos
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Home Health Care ◽  
Home Health ◽  
Activity Limitations ◽  
Administrative Records ◽  
For Profit ◽  
Home Based ◽  
Therapy Services ◽  
Physical Therapy Services

BackgroundA growing body of research suggests that greater continuity of health care is positively associated with improved outcomes of patients. However, few studies have examined this issue in the context of physical therapy.ObjectiveThe purpose of this study was to evaluate whether the level of continuity in the provider (provider continuity) of physical therapy services was related to outcomes in a population of patients receiving home health care.DesignThis was a retrospective observational study.MethodsClinical and administrative records were retrieved for a population of adult patients receiving physical therapy services from a large, urban, not-for-profit certified home health care agency in 2009. Descriptive and multivariable analyses were used to examine how the level of provider continuity, calculated by use of a formula that models dispersion in contact between the patient and the providers of physical therapy services, varied across characteristics and outcomes of patients.ResultsLogistic regression analyses indicated that patients with lower levels of provider continuity had significantly higher odds of hospitalization (odds ratio [OR]=2.06, 95% confidence interval [CI]=1.90–2.23) and lower odds of improvements in the number of activity limitations (OR=0.85, 95% CI=0.80–0.92) and in the severity of activity limitations (OR=0.85, 95% CI=0.78–0.93) between the beginning and the end of the home health care episode.LimitationsBaseline clinical characteristics associated with continuity of care suggest some level of indication bias. Outcome measures for activities of daily living were limited to patients who were not hospitalized during their home health stay.ConclusionsThese findings build upon research suggesting that continuity in the patient-provider relationship is an important determinant of outcomes of patients.

scholarly journals Ownership and Exit Behavior: Evidence from the Home Health Care Market

2016 ◽  
Vol 16 (1) ◽  
pp. 289-320 ◽  
Author(s):  
Chiara Orsini
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Capital Investment ◽  
Home Health ◽  
Health Care Market ◽  
For Profit ◽  
Not For Profit ◽  
Quasi Experimental ◽  
The Law ◽  
Exit Behavior

Abstract In the US health care system a high fraction of suppliers are not-for-profit companies. Some argue that non-profits are “for-profits in disguise” and I test this proposition in a quasi-experimental way by examining the exit behavior of home health care firms after a legislative change considerably reduced reimbursed visits per patient. The change allows me to construct a cross provider measure of restriction in reimbursement and to use this measure and time-series variation due to the passage of the law in my estimates. I find that exits among for-profit firms are higher than those of not-for-profit firms, rejecting the null that these sectors responded to the legislation in similar ways. In addition, my results expand the view that “not-for-profit” firms are a form of “trapped capital.” There is little capital investment in the home health care market, so the higher exit rates of for-profit firms after the law change indicate the possible role of labor inputs in generating differences in exit behavior across sectors.

Untapped Potential of Home Health Care Innovations to Improve Outcomes With Bundled Payment Initiatives

2016 ◽  
Vol 29 (1) ◽  
pp. 53-55
Author(s):  
Teresa Lee ◽  
Jennifer Schiller
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Home Health ◽  
Bundled Payment ◽  
Home Based ◽  
Medicare Program ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Home Based Care ◽  
Payment Models

A rapidly changing health care payment system creates opportunities for optimizing home health and home-based care for patients needing cardiac rehabilitation (CR). Home health agencies are poised to play a significant role in episode payment models in the context of post–acute care for patients with cardiovascular conditions. As the Medicare program expands its episode payment models to include patients with cardiovascular conditions, hospitals and other health care stakeholders that will be engaged in these bundled payment arrangements should consider use of home health care in the delivery of CR as a bridge to outpatient therapy and patient self-management.

scholarly journals CHANGES IN THE MEDICARE HOME HEALTH CARE MARKET: THE IMPACT OF ACA REIMBURSEMENT POLICY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S690-S691
Author(s):  
Jamila M Torain ◽  
Joan Davitt ◽  
Charlotte L Bright ◽  
Nancy Miller ◽  
Sarah Chard ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Home Health Care ◽  
Geographic Region ◽  
Home Health ◽  
Health Care Market ◽  
Free Standing ◽  
For Profit ◽  
Before And After ◽  
The Impact

Abstract This study evaluated the effect of recent ACA changes to Medicare Home Health Care (HHC) reimbursements on the mix of agencies and staff in the HHC market. We used Provider of Services (POS) data and logistic regression, to determine which agency characteristics were associated with the likelihood of exiting the HHC market and likelihood of decreasing staff before (n=13,878) and after (n=13,702) implementation of the ACA-mandated reimbursement cuts. Free standing agencies had 1.35 times the odds of exiting from the HHC market post ACA cuts. There were no differences in the odds of exiting the HHC market between for-profit and non-profit agencies. Agencies in the New York, Atlanta, and Chicago regions had a greater likelihood of exiting the HHC market post ACA cuts. Small agencies had two times the odds of exiting (aOR= 2.09) and agencies with one or more branch had less than half the odds of exiting (aOR= 0.46) from the HHC market. The average number of all staff was similar before and after the ACA cuts; however, office staff and home health aides experienced the greatest decrease in number. Agencies that were for-profit, free-standing, small, and/or with one or more branch were more likely to decrease staff post the ACA cuts. Agencies in the New York, Atlanta, Chicago, Dallas and Kansas regions were more likely to decrease staff. Overall, the reimbursement cut effects varied by geographic region and had greater impact on more vulnerable agencies and staff that were non-skilled.

scholarly journals Access to Physical Therapy Services Among Medically Underserved Adults: A Mixed-Method Study

2010 ◽  
Vol 90 (5) ◽  
pp. 735-747 ◽  
Author(s):  
Christine A. McCallum
Keyword(s):  
Health Care ◽  
Physical Therapy ◽  
Health Care Providers ◽  
Mixed Method ◽  
Physical Therapist ◽  
Medically Underserved ◽  
Care Providers ◽  
Health Care Clinics ◽  
Therapy Services ◽  
Physical Therapy Services

Background and Objectives This mixed-method case study examined access issues related to physical therapy services among medically underserved adults within an Ohio community. Design Three community health care clinics served as the units of analysis. Methods Eleven health care providers and 110 patients participated in the study, and documents from local, state, and national resources were reviewed. Results Results revealed that structural, utilization of care, and outcome barriers existed. A lack of accessible physical therapy providers for medically underserved adults and a lack of standardized screening or assessment processes to identify physical mobility problems among people with chronic health conditions were found. Inadequate knowledge about the full scope of physical therapist practice existed, which may impede access to those individuals most in need of services. Conclusions Opportunities are present for physical therapist involvement in screening, wellness and prevention, consultation, education, and program development among medically underserved adults. However, challenges exist due to a lack of human and financial resources and the current structure of our health care system, which focuses on acute and chronic care rather than prevention.

Assisting Patients to Age in Place

2011 ◽  
Vol 23 (6) ◽  
pp. 446-453 ◽  
Author(s):  
Gail Silver ◽  
Jeffrey M. Keefer ◽  
Peri Rosenfeld
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Care Program ◽  
Home Health ◽  
Practice Change ◽  
Assessment Tools ◽  
Standards Of Care ◽  
Patient Centered ◽  
For Profit ◽  
Age In Place

This article describes how one large not-for-profit home health care agency sought to stimulate a practice change among their nurses to better service the frail, complex patient population in a Long-Term Home Health Care Program (LTHHCP). This LTHHCP designed an innovative initiative that encouraged a combination of coaching techniques, assessment tools, and a range of patient-centered evidence-based practices to provide clinicians with necessary skills and competencies to provide the highest standards of care for their patients. The innovative model, called patient-centered care model (PCCM) was piloted in one service area, and a formal evaluation was integrated into the initiative to allow measurement of desired outcomes. This article describes the long- and short-term goals of PCCM, examine the components of the PCCM model, and discuss how the progress of the initiative is being evaluated and assessed.

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