Since home health reimbursement moves from cost-based reimbursement to prospective payment system, home health agencies' challenge is to continue to provide high quality care while controlling care costs. Unintended consequences in patient outcomes have been concern. The purpose of this study was to explore the nature of the relationship between home health service utilization and functional status of Medicare patients age 65 and older with heart failure. This study also determined if reimbursement period (interim payment period vs. prospective payment period) was predictive of home health service utilization and patients' functional status changes.
Donabedian's Structure-Process-Outcome framework and Andersen's Behavioral Model of Health Services Utilization were used as the basis of the integrated model for this study. The study used a retrospective and exploratory in design. Data from 1999 to 2002 were obtained from seven home health agencies in a healthcare system in a rural southeastern state. Two hundred and ninety-one heart failure patients were included in this study. Multiple regression was used the data analysis strategy used.
The more total home visits, physical therapy visits and speech therapy visits patients received, the greater their improvement in their functional status at discharge. Reimbursement period predicted of skilled nurse visits, medical social visits, and intensity of services, but not patients' functional status change. Patients who were admitted to home health agencies during the interim payment period received fewer skilled nurse visits and lower service intensity. Although the number of visits increased in the prospective payment period, no change was noted in patients' functional status.
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