Home Health Care in Medicare-Aged Patients is Associated With Increased Early Emergency Visits, Readmissions, and Costs Following Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2022-08, Vol.37 (8), p.S771-S776.e1
• Main Authors: Burnett, Robert A., Mestyanek, Christopher E., Courtney, P. Maxwell, Della Valle, Craig J.
• Format: Article
• Language: English
• Subjects: bundled payments; complications; home health; post-acute care; total knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2021.09.025

Home health services are utilized in order to provide at-home care following total knee arthroplasty (TKA). The purpose of this study is to determine whether patients receiving home health services post-operatively had lower rates of complications, emergency room visits, and readmissions as well as to determine if home health provided value by reducing total episode-of-care costs. The PearlDiver database was retrospectively reviewed to identify all primary TKA patients over 65 years old from 2010 to 2018. Patients who received home health services were matched using a propensity score algorithm to a set of similar patients who were discharged home under self-care. We compared complication rates, emergency room visits, readmissions, and 90-day episode-of-care claims costs between the groups. Multivariate regression analysis was performed to determine the independent effect of home health services on emergency department (ED) visits and hospital readmissions. Of the 185,444 TKA patients discharged home, 15,849 (8.5%) received home health services. Patients who received home health services had higher rates of ED visits at 2 weeks (3.3% vs 2.8%, P = .014) and 3 months (7.1% vs 6.5%, P = .038) as well as increased readmissions at 2 weeks (0.9% vs 0.7%, P = .028); complication rates were similar between groups (11.4% vs 10.9%, P = .159). Episode-of-care costs for home health patients were higher than those discharged under self-care ($24,266 vs $22,539, P < .001). Home health services do not appear to provide value as they are associated with significantly increased costs and do not lower the rates of complications, ED visits, or readmissions following TKA. •Home health services offer at-home care following total knee arthroplasty (TKA), however outcomes and costs associated with HH utilization are unknown.•Home health was associated with higher emergency room visits and hospital readmissions in early postoperative period.•Episode of care costs were higher in patients with home health services.