Objective

To assess whether home health agencies incur significantly higher care delivery costs for patients with cognitive impairment, across three relevant timeframes to home health payment policy.

Data sources

Linked Medicare home health claims and patient assessments, National Health and Aging Trends Study (NHATS), and home health agency cost reports, for a nationally representative sample of Medicare beneficiaries receiving home health between 2011–2016.

Study design

We modelled care delivery costs incurred by the home health agency as a function of patient cognitive impairment using multivariable, propensity score adjusted, generalized linear models.

Data collection/extraction methods

We identified NHATS participants who experienced an index home health episode between 2011–2016 (n = 1214; weighted n=,5,856,333) and linked their NHATS survey data to standardized patient assessment and claims data for the episode, as well as cost report data for the home health agency that provided care.

Principal findings

Across the first 30, 60, and 120 days of caring for a patient with cognitive impairment, we estimate additional costs of care to the home health agency of $186.19 (p = 0.02), $282.46 (p = 0.01), and $740.91 (p = 0.04), respectively.

Conclusions

Home health agencies incurred significantly higher costs when caring for a patient with cognitive impairment. As patient cognitive function is not considered in the most recent Medicare home health reimbursement model, agencies may be disincentivized from providing care to those with cognitive impairment. Policymakers and researchers should carefully monitor home health access among Medicare beneficiaries with cognitive impairment and further investigate inclusion of patient cognitive function in future risk adjustment models.