Home Health & Hospice Week

OASIS:

Think You Have Home Health Compare Down Pat? Think Again

Published on Wed Dec 22, 2004

New measures to focus on surgical wounds, incontinence, discharge and dyspnea.

Get ready to rearrange your thinking about publicly reported outcomes.

You won't have to worry about four of the 11 outcome measures currently reported in Home Health Compare, because the Centers for Medicare & Medicaid Services will be scrapping them in 2005. But you'll have four other OASIS-based measures to live up to in their place, CMS officials revealed in the Dec. 15 Home Health Open Door Forum.

Based on pending recommendations from the National Quality Forum, CMS plans to cut these measures from the comparison tool: improvement in upper body dressing, stabilization in bathing, im-provement in toileting and improvement in confusion frequency.

The following outcomes will be publicly reported in their place: improvement in status of surgical wounds, improvement in urinary incontinence, discharge to the community and improvement in dyspnea.

CMS plans to finalize the swap when the new edition of Home Health Compare debuts in late summer or early fall of 2005, an official said in the forum.

And that might be just the beginning of the changes for HHA publicly reported outcomes. CMS is moving ahead on making this change because switching one set of OASIS-based measures out for another is relatively simple.

But the NQF is in the process of voting on whether to recommend a bevy of other outcomes for public reporting, including ones that would require new duties of HHAs (see Eli's HCW, Vol. XIII, No. 39, p. 306). CMS expects to receive the final NQF recommendations by June.

"We're very interested" in the non-OASIS outcomes, the CMS staffer said. CMS and its OASIS partner, the University of Colorado, are looking at ways to collect some of the information supporting the measures in a revised OASIS tool, she added.

The new Home Health Compare version will include a Spanish Web site as well.

Other points addressed in the forum include:

OASIS revisions. CMS is looking at a plethora of recommendations for changing the OASIS tool in addition to the outcomes-related revisions. The process will require testing of changes before they can be adopted, thus revisions are still a long way off, a CMS staffer warned.

OASIS survey. One in seven Medicare-certified HHAs will receive a survey asking about OASIS practices and related costs, CMS announced. The survey, conducted by contractor Abt Associates, is part of a report required by the Medicare Modernization Act of 2003 examining OASIS duties and expenses. Agencies will likely receive the surveys by March, and the report is due to Congress by June.

Homebound demonstration. HHAs' reluctance to participate in the homebound demonstration project comes as no surprise, home care experts told CMS in the forum. The demo continues to have only one patient identified, CMS said (see Eli's HCW, Vol. XIII, No. 41, p. 322).

Medicare beneficiaries are entitled to receive up to 35 hours of services, including aide services, before another payer such as Medicaid takes over, noted Mary St. Pierre of the National Association for Home Care & Hospice. HHAs are not eager to sign up to furnish this level of aide services to patients who may qualify under the demonstration for home care.

HHS Secretary. Providers can rest assured that duties at CMS will move forward expeditiously, now that President Bush has made clear that CMS Administrator Mark McClellan will be staying on as head of the agency rather than moving up to the Health and Human Services Secretary spot. "He is remaining here as our administrator," a CMS official stressed.