The researchers also found that Medicare reimbursement for home health care was significantly lower than SNF care.
While SNF care may be more effective in limiting readmissions, home health care is less costly for the Medicare program, the researchers wrote.
"The reduction in readmissions comes at a cost for Medicare, as institutional postacute care is associated with higher Medicare payments than is providing postacute care at home. Even after accounting for the lower costs from fewer readmissions from SNFs, the total amount paid by Medicare for hospitalizations and postacute care during the 60-day posthospital period is lower for patients discharged to home compared with those discharged to an SNF."
Medicare reimbursement rules could be a factor in the lower performance of home health care in preventing readmissions, the lead author of the research told HealthLeaders.
"Because of the payment rules for home health by Medicare, it limits the intensity of care that can be provided at home. For example, patients can receive one visit per day at most. More flexibility in the way home health care is delivered would allow more intensive services to be provided in the home, which could help prevent readmissions," said Rachel Werner, associate chief for research in the Division of General Internal Medicine at the University of Pennsylvania in Philadelphia.
Postacute care is a significant element of Medicare spending —
pegged at more than $60 billion in 2015.
Reimbursement reforms and policies could be influencing patient discharge decisions.
For example, Medicare's
Hospital Readmission Reduction Program, which features financial penalties for readmissions, could be encouraging hospitals to discharge patients to the SNF setting, Werner's research team wrote. "These incentives may push hospitals to favor the use of high-acuity settings such as SNFs, and our results suggest that this strategy may be effective at reducing readmissions."
Other payment models could encourage hospitals to discharge patients to the home health care setting, they wrote. "Alternative payment models such as accountable care organizations and
bundled payments hold providers accountable for costs of care across settings and clinicians, an incentive that may push patients toward lower-cost care."