Black Americans, hospitalization, and advance care planning: Structural vulnerability in Home Health Value-Based Purchasing

Black Americans, hospitalization, and advance care planning: Structural vulnerability in Home Health Value-Based Purchasing

Skilled home health (HH) is the largest long-term care setting and the fastest-growing site of healthcare in the United States (U.S.). Home Health Value-Based Purchasing (HHVBP) is a structure of Medicare that penalizes U.S. HH agencies for high hospitalization rates. Prior studies have shown incons...

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Bibliographic Details
Published in:American journal of hospice & palliative medicine Vol. 41; no. 2; pp. 140 - 149
Main Authors: Bigger, Sharon E., Hemphill, Jean Croce, Njoroge, Trizah, Doyon, Katherine, Glenn, Lee
Format: Journal Article
Language:English
Published: Los Angeles, CA SAGE Publications 01-02-2024
Subjects:
Advance Care Planning
Aged
Black or African American
Home Care Services
Hospitalization
Humans
Medicare
United States
Value-Based Purchasing
United States
Black Americans
Quality
Goal-concordant care
Structural Vulnerability
Value-Based Purchasing
End of Life
Home health
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Summary:Skilled home health (HH) is the largest long-term care setting and the fastest-growing site of healthcare in the United States (U.S.). Home Health Value-Based Purchasing (HHVBP) is a structure of Medicare that penalizes U.S. HH agencies for high hospitalization rates. Prior studies have shown inconsistent evidence about associations of race with hospitalization rates in HH. Evidence supports that Black or African Americans are less likely to participate in advance care planning (ACP), or to complete written advance directives, which could affect their potential for hospitalization when nearing end of life. In this quasi-experimental study, we used Medicare administrative datasets, the Weighted Acute Care Services Use Rates (WACSUR) score, and the Advance Care Planning Protocol (ACPP) score to determine whether the proportion of Black HH patients in the U.S. was correlated with acute care use rates and the robustness of agency protocols on ACP. We used primary and secondary data from the U.S. from 2016-2020. We included Medicare-certified HH agencies. Spearman’s correlation coefficient was used. We found a statistical trend showing that the greater proportion of Black patients enrolled in a HH agency, the greater tendency to have a high hospitalization rate. Our findings suggest that HHVBP may encourage patient selection and exacerbate health disparities. Our findings support recommendations for alternative measures of quality in HH to include measures of goal-concordant care coordination when patients are denied admission to HH.
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ISSN:1049-9091
1938-2715
DOI:10.1177/10499091231176281