Home Health agencies shine in the medical industry by providing medical services that help to keep their patients out of hospitals or other post-acute facilities. An agency's ability to keep patients out of the hospital is significant, so we have provided a metric throughout the Solution that tracks Hospitalization rates in many tables. Hospitalization rates are defined in the Solution as the percent of patients who were hospitalized during the post-acute stay or within 30 days of discharge.
Unlike Readmission rates, Hospitalization rates do not include a reference period to another claim. Specifically, hospitalization rates to not require a previous Inpatient discharge to trigger a count in the metric. (See the video at the bottom)
There is a major section of the Home Health Detail page called Readmissions and Hospitalizations by Major Diagnostic Category that includes three tables that provide Readmission and Hospitalization metrics broken down into the 20 Major Diagnostic Categories we use in the Trella Health Solutions. These tables provide insights into the types of care and relative distribution of care provided by the agency from the page.
The last two tables in this section contain hospitalization rates presented in a cross section between Major Diagnostic Categories and patient Acuity with county and state averages included for comparison. The difference between the two tables is the reference period for the metrics. The top table includes data from hospital admission claims submitted within 30 days from the start of home Health care. The second table has a reference period of 90 days.
What is Acuity?
Patient Acuity measures the level of effort required by providers to care for a patient. This is important because differing acuity levels change a provider’s staffing, workforce education, and overall workload. For Home Health providers, this is important because those agencies that are capable of care for patients with higher acuity must increase their investments, whereas agencies that do not make the same investment are not prepared to handle such patients.
For an extensive explanation of this concept, see Trella Health Patient Acuity.
Understanding the Data
Break it down
This table has a mountain of metrics. So let's break it down into the basics:
- MDCs - Each Row contains a single Major Diagnostic Category. This allows you to narrow the focus of your evaluation to a specific set of patients who have similar care needs.
- Acuity - For any row we have four measures of acuity, an overall view and then, low, medium and high. Against the first section baseline, the level of effort required increases.
- County and State - Each of the four acuity sections includes county and state averages for comparison
- 30 and 90 days - The only difference between the two tables is the length of the reference period from the start of home health care. The calculations for each table will only include hospitalization claims that fall within the reference period. This means that the 30 day table is a subset of the 90 day since any claim that occurs during the first 30 days will always fall within the first 90 days. The parallel metrics in the 90 day table will always be higher.
- Highlighting - Any hospitalization rate that is higher or lower than both the county and state comparisons are highlighted; red if the metric is higher, green if it is lower.
In this table, Home Health agency patient population is delineated by patient acuity. Patients are grouped so you can identify performance in the servicing of more complex patients. You can also differentiate your agency from the competition by identifying more “difficult” patient populations where you have better patient outcomes. This will enable a positive message to hospitals and physicians that specialize in higher acuity patients. Similarly, agencies that may have better overall performance measures could be identified by indicating their “easier” patient population.
The following approaches are helpful when considering this table. As always, observations of data in this table provide some concrete conclusions but also suggest further investigation. Sometimes the answer is about the agency and their performance, sometimes the driving force is the patients with a diagnostic category.
- Start at the Top - The content in this table is sorted with the largest patient population treated by the home care agency at the top. Unless you have a patient population (diagnosis) already chosen for consideration, this is a good place to start. Since this is the largest patient population, it provides the greatest overall understanding of the agency's performance. Why does this agency have a predominance of this diagnosis? What does the performance against the market averages reveal about this agency? Does this demonstrate a competitive advantage or a focus for improvement?
- Pick a color - The highlight colors provide an immediate view of areas of excellence (green) and areas requiring improvement (red). The most common color provides an good general assessment of the agency overall.
- Row, Row, Row your metric - looking across a row gives an interesting view of treatment within a single treatment discipline. The table above shows that the home health agency performs poorly overall with Injury and Poisoning (against the county and state averages), but somehow excels with the highest acuity patients. Although the HHA should improve those metrics overall, they can certainly promote themselves with respect to the hardest patients in that diagnostic category. A mix of higher and lower performance across the row does raise questions, What is causing the gap? Why is the agency excelling with one level of difficulty and not with another? What does this say about agency staffing or allocation of other resources?
- Consistent Columns - The column sections represent similar levels of acuity. The home health agency represented in the table above has more green than red in overall acuity and in the high acuity categories. This agency seems to work best with the highest acuity patients. That is the competitive advantage that this agency has.
- Comparing Tables - All of the strategies work for each table, whether the reference period is 30 or 90 days. Remember that the 90 day table will always have higher numbers since the longer period includes all patients who were hospitalized in the first 30 days AND the next two months. When comparing these two tables, success indicates that the home health agency was able to stabilize the patients and keep them out of the hospital. We expect high acuity patients to hospitalize more often and more quickly, but an agency that is able to prevent higher acuity patients from being hospitalized has provided excellent care. We can see, in this combined image, the 30 and 90 day metrics. In both the overall and Medium Acuity columns, the agency improved from red to white. For patients requiring longer care, this agency can claim improvement.
This video includes some basics of understanding how we present Hospitalization data in the Trella Health Solutions.