The Journal of Emergency Medicine publishes West Health and UCSD study on home health costs as an alternative to hospital care


The Journal of Emergency Medicine has published the following peer-reviewed article, which provides cost savings evidence for home health care.

West Health has recognized that home-centered care can be a focal point for seniors, offering the option for effective care provided within the safety and comfort of home. The study described in this paper was designed in collaboration with the UCSD Department of Emergency Medicine in order to explore the possibility of providing home-based acute care options. This is particularly focused on rigorously establishing foundations of financial sustainability for this option against the backdrop of new, emerging Medicare payment structures.

Authors include: Christopher Crowley, PhD; Amy R. Stuck, RN, PhD (both of West Health); Tracy Martinez, RN; Alan C. Wittgrove, MD; Feng Zeng, PhD (West Health); Jesse J. Brennan, MA; Theodore C. Chan, MD; James P. Killeen, MD and Edward M. Castillo, PhD, MPH.



Almost 70% of hospital admissions for Medicare beneficiaries originate in the emergency department (ED). Research suggests that some of these patients’ needs may be better met through home-based care options after evaluation and treatment in the ED. Objective: We sought to estimate Medicare cost savings resulting from using the Home Health benefit to provide treatment, when appropriate, as an alternative to inpatient admission from the ED. Methods: This is a prospective study of patients admitted from the ED. A survey tool was used to query both emergency physicians (EPs) and patient medical record data to identify potential candidates and treatments for home-based care alternatives. Patient preferences were also surveyed. Cost savings were estimated by developing a model of Medicare Home Health to serve as a counterpart to the actual hospital-based care. Results: EPs identified 40% of the admitted patients included in the study as candidates for home-based care. The top three major diagnostic categories included diseases and disorders of the respiratory system, digestive system, and skin. Services included intravenous hydration, intravenous antibiotics, and laboratory testing. The average estimated cost savings between the Medicare inpatient reimbursement and the Home Health counterpart was approximately $4000. Of the candidate patients surveyed, 79% indicated a preference for home-based care after treatment in the ED. Conclusions: Some Medicare beneficiaries could be referred to Home Health from the ED with a concomitant reduction in Medicare expenditures. Additional studies are needed to compare outcomes, develop the logistical pathways, and analyze infrastructure costs and incentives to enable Medicare Home Health options from the ED.  2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (

Please click here to read the article for free at the Journal of Emergency Medicine’s site, provided courtesy of West Health.