Abstract:
The Medicare Home Health Agency Pay for Performance Demonstration was designed to test whether providing monetary performance incentives for home health agencies would improve patient outcomes and result in cost savings to Medicare. The demonstration evaluation has employed multiple research methods to ascertain the effects of the demonstration on home health agency practices and patient outcomes, as well as conducting analyses to examine agency characteristics of demonstration participants compared to other home health agencies, and comparing performance of both treatment and control agencies with other, non-participating agencies in terms of Medicare costs. Analyses completed using data from two years of the demonstration include: 1. Comparison of agency characteristics among treatment, control, and non-participating home health agencies in demonstration states. 2. Comparison of total cost of health care provided to Medicare beneficiaries served by non-participating home health agencies in demonstration states, to complement analysis conducted by the implementation contractor of cost comparisons between treatment and control participants in the demonstration. 3. Comparison of outcome quality measure performance among treatment, control, and non-participating home health agencies in demonstration states, including both cross-sectional and trend analysis. 4. Qualitative analysis of clinical and quality improvement activities of agencies participating in the demonstration, focused particularly on high performing agencies, utilizing information collected during site visits and conversations with participating providers. 5. Analysis of responses to a survey of agencies participating in the demonstration regarding changes in organizational structure, staffing, and practices in response to the demonstration. Volume 1 covers the first three analyses listed above. The site visit and survey analyses are summarized in separate deliverables, which constitute Volumes 2 and 3 of the Final Report.