Pmu65 evaluation of home health for patients eligible for the post-acute care transfer policy

The CMS Post-acute Care Transfer (PACT) policy distributes payment across healthcare settings for patients with a shorter than average hospital length of stay (LOS) and specific Diagnosis Related Groups (DRG) who require post-acute care such as home health (HH). In 2018, patients were PACT eligible if they were discharged for any of the 280 PACT policy defined DRGs with an LOS shorter than the geometric mean for the DRG. To investigate the potential benefits of this policy, we assessed differences in re-admissions and healthcare costs between PACT eligible patients discharged to HH and those discharged to home with no home healthcare. Patients enrolled in Medicare Advantage with a PACT eligible discharge in 2018 were evaluated for this retrospective, claims analysis of a large national health plan. Index was the date of discharge. Patients with a claim for HH services within 7 days post-index comprised the HH group. Patients discharged to home with no claim for HH in the 90-day post-index period were the comparison group. Cox proportional-hazards models with an instrumental variable (hospital-level probability of HH referral) and adjustment for case-mix were used to assess all-cause readmissions post-index. Post-index total healthcare costs were modeled using generalized estimating equations fit to a gamma distribution. There were 3,753 HH patients and 13,342 home only patients in the study cohort. HH patients were older [mean age 71.7 (+/- 7) vs 70.8 (+/-9)], more frequently female (58.5%), with mostly surgical DRGs (85.4%). For HH patients, the risk of 30-day readmission was reduced by 60%, 60-day by 45% and 90-day by 37%. Healthcare costs were 11% lower for the HH group. For PACT eligible patients, the provision of additional healthcare services in the home setting was associated with fewer hospital re-admissions and reduced total healthcare costs, including costs of home health.