Frontloading of home health visits has been described as a strategy for reducing unnecessary hospital readmissions, yet there is no consistent practical definition. This study examines visit characteristics of post-acute home health episodes for heart failure patients in the Medicare fee-for-service population and explores whether alternative definitions can empirically distinguish frontloaded episodes. Using 100% Medicare claims and enrollment data for 2016 and 2017, we descriptively examine the first post-acute home health episodes occurring after discharge for patients with heart failure as a primary diagnosis. We use the number and timing of visits during 60-day episodes highlight two definitions of frontloading related to the existing empirical literature. Among heart failure home health episodes, almost 24% meet one definition of frontloading (60% of visits within 14 days) and 40% meet the second definition (3 or more nurse visits in 7 days). Little overlap exists between the populations identified by the two definitions. Each definition relates to patient need and represents a threshold chosen within a distribution of care, rather than distinguishing a type of care. Without an agreed upon empirical definition, observational studies measuring the effects of frontloading on outcomes may differ in patients identified as receiving frontloaded care. Furthermore, statistical methods to control for patient need may result in measuring the effects of marginal changes in care, estimating small or indistinguishable effects of frontloading on patient outcomes.
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