Quality Performance of Rural and Urban Home Health Agencies: Implications for Rural Add-On Payment Policies

Purpose To examine the differences in quality performance among agencies in urban areas and those in high utilization, low population density, and all other rural areas, defined in the Bipartisan Budget Act (BBA). Methods We conducted a retrospective study using 2015 data: the Home Health Compare, the Home Health Agency Utilization and Payment Use, the Provider of Services, and the Area Health Resources Files, and a file with rural categories in BBA. The quality measures included (1) hospitalizations, (2) emergency visits, (3) patient experience, (4) composite scores for improvement in activities of daily living (ADL), (5) improvement in pain and treating symptoms, (6) preventing harm, and (7) treating wounds and preventing pressure sores. We applied weighted least squares regression. Findings Among all quality measures, differences in emergency visits of the 3 rural categories from urban agencies were the largest. The adjusted mean emergency visit for urban agencies was 12.42%, with agencies in rural areas having 1.01-1.96 percentage points higher rates than urban agencies (95% CI: 0.72-1.29 for high utilization areas, 95% CI: 0.51-3.42 for low population areas, and 95% CI: 1.28-1.78 for all other areas). Conclusions The differences in the quality of care among agencies in 3 categories of rural areas were small, except for emergency visits. Given policies to reduce rural add-on payments for home health services, continued monitoring of the services provided and the quality of care by home health agencies in rural areas is recommended.