Home health care after TKA may not provide value for Medicare-aged patients
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Home health care for Medicare-aged patients who underwent total knee arthroplasty was associated with increased costs with no improvements in complications, ED visits or readmissions, according to published results.
Researchers retrospectively reviewed data from the PearlDiver database on 15,849 patients (average age of 71.5 years) who received home health services after a TKA from 2010 to 2018. They also analyzed a propensity score-matched cohort of similar patients who were discharged home under self-care.
According to the study, home health services were defined as “short-term home-based care by a registered nurse” with services including “wound care and surveillance, patient and caregiver education and nutritional interventions.” Outcome measures included complication rates, ED visits, readmissions and 90-day episode-of-care claims costs.
While complication rates were similar between the cohorts, researchers found patients who received home health care had higher rates of ED visits at 2 weeks (3.3% vs. 2.8%) and 3 months (7.1% vs. 6.5%), as well as increased readmissions at 2 weeks (0.9% vs. 0.7%) compared with patients who were discharged to self-care. Episode-of-care costs were also higher in patients who received home health care compared with those discharged to self-care ($24,266 vs. $22,539, respectively).
“As projected volume for TKA continues to rise, it is imperative to evaluate various aspects of post-acute care, including home health nursing care,” the researchers wrote in the study. “Home health care does not appear to add value as these services are associated with increased costs with comparable rates of complications and increased ED visits and readmissions following TKA.”
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