Public Reporting and Market Area Exit Decisions by Home Health Agencies

DESCRIPTION (provided by applicant): Public reporting of quality information has been actively promoted in health care during the past decade, with the expectation that it gives providers an incentive to improve quality. As public reporting rapidly expands to several settings, an important policy concern has been raised that public reporting may unintentionally exacerbate disparities in health care. Public reporting programs may disadvantage providers serving underserved populations, whose quality of care may be costly to improve. This implies that those providers may receive little financial rewards from public reporting programs, and to avoid this disadvantage, they may reduce services for underserved people or leave communities with those populations. Our proposed study will examine the impact of Home Health Compare (HHC), a Medicare public reporting initiative, on access to home health care among disadvantaged populations. Specifically, we will examine whether agencies selectively discontinued service to areas with socio-economically disadvantaged populations after Medicare introduced HHC in 2003. We will assess agencies'initial responses to HHC by analyzing market area exits between 2002 and 2004. We will identify agencies'service areas using the Outcome and Assessment Information System (OASIS) data and will obtain market area information from the Census file and Area Resource File (ARF). We will use logit estimation to analyze the data and will account for clustering within an agency employing the Generalized Estimating Equations (GEE) technique. The findings of this study will provide policy makers with important information that can be used to design or refine public reporting programs. PUBLIC HEALTH RELEVANCE: As demand for home health care increases, ensuring access to high quality home health care is essential. This study proposes to examine the impact of a public reporting program on access to home health care among socio-economically disadvantaged populations. Specifically, the proposed study will look at whether home health agencies discontinue service to market areas with disadvantaged populations after public reporting.