Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access

Shekinah A. Fashaw-Walters, Momotazur Rahman, Gilbert Gee, Vincent Mor, Maricruz Rivera-Hernandez, Ceron Ford, Kali S. Thomas

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Policy Points Public reporting is associated with both mitigating and exacerbating inequities in high-quality home health agency use for marginalized groups. Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does. Targeted federal, state, and local interventions should focus on raising awareness about the five-star quality ratings among marginalized populations for whom inequities have been exacerbated. Context: Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high-quality, long-term care for older adults. The objective of this study is to evaluate the impact of the home health five-star ratings on changes in high-quality home health agency use by race, ethnicity, income status, and place-based factors. Methods: We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high-quality home health agencies between July 2014 and June 2017. To estimate the impact of the home health five-star rating introduction on the use of high-quality home health agencies, we use a longitudinal observational pretest–posttest design. Findings: After the introduction of the home health five-star ratings in 2016, we found that adjusted rates of high-quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. Additionally, we found that the disparity in high-quality home health agency use between low-income and higher-income home health patients was exacerbated after the introduction of the five-star quality ratings. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high-quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high-quality home health agency use. Other neighborhoods experience a nonsignificant change in high-quality home health agency use. Conclusions: Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low-income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Targeted interventions should focus on raising awareness around the five-star ratings.

Original languageEnglish (US)
Pages (from-to)527-559
Number of pages33
JournalMilbank Quarterly
Volume101
Issue number2
DOIs
StatePublished - Jun 2023

Bibliographical note

Funding Information:
: This work was supported by the National Institute on Aging [1R36‐AG068199]. Funding/Support

Publisher Copyright:
© 2023 The Authors. The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Milbank Memorial Fund.

Keywords

  • access
  • home health
  • public reporting
  • quality
  • racial inequities

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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