Home Health Agencies & Home Health Care: An Examination of Financial Performance, Quality, and Micro-Costing

Abstract

Home health represents a key healthcare delivery provider for millions of Americans. Amongst those receiving home health care, approximately 3 million are Medicare recipients. Home health agencies (HHAs) are a key provider as there are roughly 11,500 HHAs providing home health services ranging from skilled nursing care, disease management, physical and occupational therapies, and wound care. HHAs are mainly for-profit entities. Financial performance has traditionally been a source of study for other types of long-term care organizations with regards to organizational characteristics and quality of care outcomes. As a major provider of healthcare, it is worthwhile to evaluate the relationship HHA organizational characteristics have on their financial performance, as well as the construct of HHA financial performance on quality. The purpose of this dissertation is to consider HHAs from the perspectives of their organizational characteristics, financial performance, and quality. Therefore, this dissertation consists of three studies: (1) an observational, cross-sectional study that looks at the possible correlation between HHA organizational structure (for-profit vs. non-profit), chain status (affiliation with a parent company) and financial performance, (2) an observational, cross-sectional study examining the relationship between HHA financial performance and Home Health Compare (HHC) quality star ratings, and (3) a Time-Driven Activity Based Costing (TDABC) that assesses an at home oxygen monitoring costing for recently discharged COVID-19 patients. In summary, this dissertation contributes to the home health literature by examining HHA organizational characteristics on financial performance, which may also correlate with quality. Additionally, this dissertation provides information on assessing the costs of remote, in-home care options and the associated cost drivers.