Identifying Hospital Discharges for Home Health Service

Filed under White Papers & Case Studies

The Challenge
A home health agency affiliated with a multi-hospital health system believed there were a significant number of unidentified patients discharged from hospitals who would benefit from home health services. The agency came to Healthcare Market Resources, Inc. to help determine which hospitals provided the greatest opportunity for increasing home care referrals.

HealthMR’s Expertise
The client purchased Medicare Hospital Discharges to Home Care by Diagnostic Related Group (DRG) Reports for more than 20 hospitals within their service area. The group included hospitals within their own system and those that were part of several competing hospital systems with captive home health operations and different types of hospitals including academic medicals centers directly affiliated with a medical school, teaching hospitals with residency programs, and community hospitals.

The reports provided the agency with the number of patients by major DRG each hospital discharged to home healthcare, self-care (no care), or a medical facility. In addition, the reports also included the best practices for nationwide hospital discharge practices against which local market and individual hospital performance could be benchmarked. In this particular service area, the hospitals typically compared themselves to regional peers rather than the regional average. With the data obtained from the Healthcare Market Resources’ reports, the home health agency created benchmarks for the different types of hospitals and compared member institutions to the appropriate standard.

The Outcome
Thanks to the Healthcare Market Resources’ reports, the agency identified the hospitals that provided the greatest opportunity for decreasing hospital re-admissions by increasing home care referrals. The agency met with finance department representatives of these hospitals and presented their findings. At that time, the senior leadership position in charge of case management for these hospitals was vacant. Given the enormity of the change needed, the finance teams were concerned that the patient discharge data represented a one-time aberration. Also, because of the leadership vacuum, the finance representatives were reluctant to tackle the issue.

The agency purchased the reports for a second year, which confirmed their previous patient discharge conclusions. In the meantime, a vice president for case management was appointed and physicians in their service area began to be penalized for hospital re-admissions. As a result, hospital management’s view of the agency changed from regarding them as an interloper to becoming part of the solution.

In this situation, part of the challenge was inadequate discharge planning resources available to touch Medicare patients on a timely basis. Therefore, the agency offered the data to provide a statistical foundation for justifying additional resources within case management. The agency also shared the reports with discharge planners to encourage a change in behavior for key DRGs – specifically patients who were candidates for the agency’s telehealth program and essential to the hospitals’ disease management programs.

In summary, the Medicare Hospitals Discharges to Home Care by DRG Reports helped the home care agency:

  • Confirm the number of unidentified home care candidates
  • Support the cost-benefit analysis for additional discharge planning staff
  • Focus its efforts to change discharge planning behavior in areas with the highest potential

If you’re interested in learning more about how Healthcare Market Resources’ reports can help generate similar results for your agency, contact us at 215-657-7373 or info@nullhealthmr.com.