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Treatment vs. control groups in P4P
A survey of 219 home health agencies participating in the Centers for Medicare & Medicaid Services' Home Health Pay for Performance (P4P) demonstration doesn't show dramatic differences between treatment group agencies and control group agencies in the approaches taken to improve quality of care, but it does give a good picture of the range of strategies used by HHAs.1
Control home health agencies were more likely to add staff functions than treatment group agencies, with 45.6% of the control group adding RNs, compared to 35.3% of treatment group.
More than half of all agencies (50% of treatment group and 55.3% of control group) received help from Quality Improvement Organizations to reduce acute care hospitalizations, and more than half (58.6% of treatment group and 54.4% of control group) of agencies that are part of a larger corporate organization received corporate help to reduce acute care hospitalizations.
Treatment group agencies are more likely than control group agencies to implement new policies related to falls prevention programs (56% vs. 48.5%).
Treatment home health agencies are more likely than control home health agencies (50.9% vs. 40.8%) to have implemented a policy to increase the quantity or quality of communication with patients.
Treatment group agencies are more likely to implement the use of care pathways or standardized treatment plans than control agencies (29.3% vs. 20.4%).
Control home health agencies are more likely than treatment agencies (31.1% vs. 18.1%) to have changed policies regarding productivity requirements for staff members.
More than half of both groups reported that they have implemented performance improvement programs.
Treatment group agencies report implementation of additional review activities 55.2% compared to 45.6% of the control group.
Treatment home health agencies are more likely to introduce new staff education programs (42.2% vs. 32%) than control group agencies.
Cost of P4P
More than half of all agencies (53.4%) reported less than a 1% change in costs for participation in the demonstration, and 22.4% reported a 1% to 5% increase in cost.
Home health agencies believed that the demonstration would have the greatest impact on acute care hospitalizations (69%) and management of oral medications (72.4%).
1. Nuccio E, Richard A, Hittle D, et al. June 2010. Comparison of Treatment Versus Control Home Health P4P Demonstration Participants: Survey Findings. Poster session presented at the AcademyHealth Annual Research Meeting, Boston, MA.