Home Health & Hospice Week

The fate of your home health agency could depend on the 11 outcomes the Centers for Medicare & Medicaid Services has chosen to hold up for public comparison.

Fare well and your reputation - and admissions - could soar. Fare poorly and you could be dismissed as a poor quality, even dangerous home care provider.

The following 11 outcomes, chosen for the eight-state home health quality improvement pilot project, are expected to remain about the same for the national roll-out in October. They describe the percentage of patients who:

1. Get better at getting dressed.

2. Get better at bathing. 3. Are confused less often.

4. Get better at taking their medicines correctly (by mouth).

5. Get better at walking or moving around.

6. Get better getting to and from the toilet.

7. Get better at getting in and out of bed.

8. Have less pain when moving around.

9. Stay the same (don't get worse) at bathing.

10. Need urgent unplanned medical care.

11. Had to be admitted to the hospital.

The wording of the outcomes is the draft language CMS plans to use on the Home Health Compare Web site and in newspaper ads. The language is currently being tested with consumers and could undergo changes. The information will stress that it's better to have higher percentages with numbers 1 through 9 and lower percentages with 10 and 11, CMS says on its HHQI Web site.

The outcome related to improving at dressing oneself pertains to the upper body, CMS says.

Many HHAs have been disappointed at how the chosen outcomes focus on functionality rather than clinical status, notes Joie Glenn, executive director with the New Mexico Association for Home Care. Agencies tend to think clinical outcomes more accurately reflect the quality of care an agency provides, adds Mary St. Pierre with the National Association for Home Care.

But beneficiaries and their families just can't understand some of those clinical outcomes, OBQI contractors found in consumer testing.

Meanwhile, including a non-risk adjusted outcome - improvement in pain - in the list is a wrong step, insists consultant Linda Krulish with Home Therapy Services in Redmond, WA. "I don't think it is appropriate to report and compare non-risk adjusted outcomes to a public" already befuddled by - and often indifferent to - the wealth of data offered to them, Krulish tells Eli.

CMS originally planned for the outcomes on pain, urgent unplanned medical care and hospital admissions to lack risk adjustment, but now it appears that only the pain outcome will be non-risk-adjusted. Despite a brief explanation of risk adjustment that will accompany the outcomes comparison numbers, potential patients and even referral sources are unlikely to understand that a sicker patient population - not agency quality - might be responsible for lower outcomes, observers expect.

The validity of the OASIS data that makes up those outcomes stats also is questionable, cautions St. Pierre. Many HHAs still are confused about how to answer OASIS MO questions, and sometimes regional home health intermediaries are giving instructions that directly conflict with the OASIS instructions from CMS, she says.

The result is that some lower patient outcomes may indicate problems with documentation and OASIS, not problems with patient care.