Keeping Patients at Home After Home Healthcare Discharge
HHA's risk-standardized rate of Medicare FFS patients who are discharged to the community following a HH episode, and do not have an unplanned readmission to an acute care hospital or LTCH [long term care hospital] in the 31 days following discharge to community, and who remain alive during the 31 days following discharge to community (CMS, 2016).
Therefore, HHAs are evaluated not on the absolute number of readmissions, but on the excess, or risk-standardized rate based on the projected rate.
The VNAA-AHHQI Work Group began by examining current agency practices used to identify risk factors for readmission and prepare patients for discharge. The group reviewed current evidence and found little research specific to readmissions after home healthcare discharge. Expert consensus identified a number of key priorities.