Medicare and Home Health Care

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Updated: Mar 28, 2022
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The health care system faces many issues and concerns when treating patients. One of the many issues are readmission rates. Patients are often treated then return to the hospital again with relapse, recurrence of illness, or new deterioration of condition. Readmission rates put a very big burden on the medical system and health insurances. According to data from the Center for Health Information and Analysis, “Hospital readmissions cost Medicare about $26 billion annually, with about $17 billion spent on avoidable hospital trips after discharge.

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” (LaPointe). “Studies have shown that as many as 40 percent of patients over 65 had medication errors after leaving the hospital, and 18 percent of Medicare patients discharged from a hospital are readmitted within 30 days.” (Family Caregiver Alliance). The health care system continues to strive for a solution to decrease readmission rates. One solution may be the use of home health care. Home health care decreases costs, improves health outcomes, and reduces hospital stays quote 2. With healthcare costs in general increasing yearly, readmission rates will continue to be an area of concern and importance if the healthcare industry wants to survive and be financially stable and adhere to quality outcomes as mandated by CMS. (source CMS) This paper will address readmission rates, contributing factors, and how home health care aligns as a solution to decreasing readmission rates.

The United States spends more on health care than any other nation in the world. The centers for Medicare and Medicaid Services (CMS) states “Health care spending grew by an average of 4.6% in 2017, reaching nearly $3.5 trillion. CMS estimated that U.S. health care spending would reach about $5.7 trillion by 2026.” (Advisory Board). Hospital care is expected to increase from $698 billion in 2017 to $1.1 trillion in 2026 (Advisory Board). Hospital readmissions effect the economy. With growing and national attention on cost containment, unplanned readmissions have become a focus of healthcare payers, policy makers from the government, and providers. The centers for Medicare and Medicaid Services (CMS) have started to penalize hospitals for readmissions by changing their reimbursement payment for care. Besides the financial burden hospital readmissions cause and effect the economy overall, there is a less obvious cost – a heavy emotional and health toll on patients and their families.

There are many factors that contribute to readmission rates. Patients get discharged from hospitals which are very supportive medical environments to their home where access to medical skill and knowledge do not exist. It is not easy for recovering patients to take care of themselves. Some patients do not even have caregivers to assist with their needs. Patients are also faced with new medical diagnoses, new medicine regimes, and sometimes still are not fully recovered during their discharge experience (Beresford). Certain diagnoses sometimes contribute to high readmission rates such as heart conditions and infections. In Missouri from 2009-2012, a state wide program to reduce hospital readmissions was analyzed. It’s findings revealed Congestive Heart Failure, Pneumonia, and Myocardial Infarction were some of its biggest diagnoses for hospital readmission (Beresford). It was also found that socioeconomic factors also effect readmission rates in another study. Researchers at a Missouri urban teaching hospital found that “Patients living in high-poverty neighborhoods were 24% more likely to be readmitted to the hospital within 30 days, after adjusting for demographic and clinical characteristics.” (Beresford). Patients get discharged with more complex at-home care needs than in the past and are still very weak and sick. “Changes in clinical condition places increased demands on the patient’s ability to care for himself or herself, while at the same time making it more difficult to provide self-care.” (Nauert). Patients also can be discharged too early and that can heavily influence a patient’s need to go back to ER and become readmitted. Factors influencing early discharge may be insurance coverage rules and guidelines. “That is, at some point they can no longer make enough money to make it worth their while to keep you there.” (Torrey). If the hospital can no longer be reimbursed for the care they are providing, a discharge will inevitably happen. Infection is another factor that influences early discharge. The hospital system may want to discharge patients prior to an infection presenting itself (Torrey).

Home health care can offset some of the burden hospital’s face with readmission rates as it can assist patients to transition to their home setting again. “Home health staff provide and help coordinate the care and/or therapy a patient doctor orders.” (Medicare and Home Health Care). Home health care assists patients to manage their health and educate them about their disease and illness. Its underlying goal is for the patient to regain their independence and be as self-sufficient as possible (Medicare and Home Health Care). Home health care can include skilled nursing, physical and occupational therapy, speech therapy, medical social services, and home health aide (Medicare and Home Health Care). Many patients in the hospital are told about home healthcare if their doctor believes they qualify for it. Although they are told about it, a doctor has to write an order for it and the patient has a choice whether they want it or not. In many cases, sometimes hospitals will discharge patients too early or the patient will decline home health care because they don’t understand the importance of actually needing the assistance. When a patient accepts home health care, there’s still always a chance of readmission, but usually the chances of it reoccurring are less if the patient is cared for by a home care agency. If a patient is denied home health care or declines the care themselves, they often end back in the hospital due to complications. (source)

Home health care can also assist in patient education. Many hospitals operate on capacity meaning they don’t want to always keep their beds full and are quick to get rid of patients as fast as they can despite the condition they may be in. Early hospital discharge creates a major gap in the patient, family, and caregiver education. “Seniors are at increased risk for poor outcomes during the transition process particularly when the move is into a long term care facility.” (Fowler). When a patient is discharged from the hospital the stress of the transition might be too much for them. There might be a miscommunication or misunderstanding when it comes to information from the doctor to the patient. The patient and family might not quite understand the medication they’re prescribed, what it does, and how often it should be taken. Home health care can also offer a patient continued intermittent oversight of their condition when it is unfeasible to stay in a hospital setting for long term. Such conditions and situations include chronic wounds, chronic disease management, monthly catheter changes, at-home IV drug therapy, adherence to a new med regime, evaluation of drug therapy, ostomy management. (source) Home health care can serve as an intermediate between patient and doctor in between patient doctor appts. Home health care can provide good patient education. With that, comes patient engagement. Home health care can improve patient engagement that hospitals cannot provide during the short time patients are there. Lack of patient engagement could lead to hospital readmission. “Patient engagement is the act of patients and providers working together toward the end goal of improved patient wellness (Patient Engagement HIT).

There is a process to qualify for home health care. Right before a patient is discharged from the hospital, they are told about home health care by the discharge planner, nurse, or social worker. The doctor will then write a script for home health care for the patient and the patient has a choice if they will follow through with it or not. If a patient requires home health care after readmission, there is a specific criteria they need to meet in order to qualify. The patient must be considered homebound meaning they need assistance of another person or medical equipment like crutches, a walker, or wheelchair to leave the house. Also, the doctor might believe that the patient’s health could become worse if they were to leave their home, so ultimately they order them to stay at home. The patient might require skilled care due to their condition they’re in. This means that a registered or licensed practical nurse will come to the patient’s house to monitor their condition and see if it changes. Sometimes the job of a skilled nurse can be acting as a caregiver for the patient, educating the patient and family about the medication they need to take and when to take it, assisting with a wound or another medical service, disease management, offering emotional support for the family or patient, assistance with daily life activities, and anything else the doctor may ask the skilled nurse to complete during the scheduled visits. Also, the patient must be under care from a provider who documents any and all in-person visits either three months before the start of home health care or within one month after home health care has begun. (The My Medicare Matters Team).

In conclusion, Hospital health care systems will continue to examine and study ways to decrease hospital readmission ratees for the future to reduce the cost of hospital readmissions. “In 2018, nearly one in six Medicare patients have returned to the hospital within one month of discharge, costing the healthcare industry an estimated $25 billion.” (Diacopoulos). It is expected that readmission cost nation-wide will increase as the aging population continues to increase. With this, the number of people with chronic health conditions will rise (Diacopoulos). One possible solution to the problem of readmission rates in our health care system is to make a discharge plan for the patient before they leave the hospital including a referral to home health care as long as the doctor believes the patient qualifies for it and needs it. Great discharge planning is a way to decrease the chances that the patient gets readmitted into the hospital. It also helps to aid in the recovery process and to make sure medications that are prescribed are given the right away. “Both the American Medical Association and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) offer recommendations for discharge planning.” (Family Caregiver Alliance). To create a great discharge plan, the doctor or nurse must evaluate the patient, discuss and plan for the patient to be transferred to another care facility or home health care, creating referrals for home health care, and finally, arranging any follow-up appointments or tests for the patient in the future (Hospital Readmission Studies). Many factors can contribute to readmission rates such as types of diagnoses, socioeconomic status, patients going home to less supportive environments versus the hospital, complicated medical needs at home, insurance coverages, and too early discharges from hospital systems for various reasons. Home health care can assist hospitals in reducing their readmission rates by helping patients transition to home. Home health care can be a strong force to assist patients to gain knowledge of their disease and illnesses, help them learn what to do in the home and how to take care of themselves independently and/or with the assistance of a caregiver. When patients engage in their care, the overall hopeful goal is that they start to take better care of themselves (Rodocker). Home health care can assist hospital and doctors with on-going in-home care needs of their patients and provide oversight on certain diagnoses and situations that under normal circumstances, could not be addressed in a hospital setting due to time constraint of a patient being there nor during infrequent doctor appts or clinics. Home health care is cost effective. Home health care can have a big impact on reducing care spending and reducing hospital readmissions by treating more patients at a fraction of the cost as other care settings such as hospitals and skilled facilities (Rodocker). Clinical infectious disease did a study that quantified cost savings of a home IV antibiotic program for Medicare. “The average cost per day of home therapy was $122, compared to $798 in the hospital and $541 in a skilled nursing facility (AAHomecare). “Home health care can act as an adjunct and can become essential in reducing hospital readmissions by offering skilled care in the home as a client transitions to their home setting and providing interventions to assist the patient to remain home and out of the hospital. In the New England Journal of Medicine in 2010 stated “Ultimately, health care organizations that do not adapt to the home care imperative risk becoming irrelevant. It seems inevitable that health care is going home.” (AAHomecare).

Work Cited

  1. AAHomecare. (2017, December 6). Cost-Effectiveness of Homecare. Retrieved December 1, 2018, from
  2. Advisory Board. (2018, February 15). How much did the US spend on health care last year? $3.5T, according to CMS. Retrieved December 1, 2018, from
  3. Beresford, L. (2018, September 14). Nonclinical Factors Influence Hospital Readmissions. Retrieved November 26, 2018, from
  4. Diacopoulos, E. (2018, November 19). Readmissions on the Rise. Retrieved November 30, 2018, from
  5. Fowler, K. (2016, September 07). Hospital Discharge: One of the Most Dangerous Periods for Patients. Retrieved November 26, 2018, from
  6. Family Caregiver Alliance. (n.d.). Hospital Discharge Planning: A Guide for Families and Caregivers. Retrieved November 26, 2018, from
  7. Hospital readmission studies: Influencing factors identified. (2010, October 13). Retrieved November 30, 2018, from
  8. LaPointe, J. (2018, January 08). 3 Strategies to Reduce Hospital Readmission Rates, Costs. Retrieved November 26, 2018, from
  9. Nauert, R., PhD. (2015, October 06). Caregiver Factors Influence Hospital Readmissions. Retrieved November 30, 2018, from
  10. PatientEngagementHIT. (2016, October 17). The 3 Building Blocks Supporting Patient Engagement Strategies. Retrieved December 1, 2018, from
  11. Rodocker, B. (2018, September 4). What is Patient Engagement? Retrieved December 1, 2018, from 
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Medicare and Home Health Care. (2021, Oct 18). Retrieved from