Home Health & Hospice Week

Don't let a slow start on QI cost you later.

You'd better get moving now to show improvement in your patient outcomes before they affect your bottom line.

Pay for performance methodology is bound to start any time now, predicted Pamela Teenier with Gentiva Health Services in an Oct. 25 session on P4P at the National Association for Home Care & Hospice's 24th annual meeting in Seattle.

If P4P for home health agencies takes effect in 2007 as currently proposed, "it seems like a really long time from now," Teenier acknowledged. But thanks to the time it takes quality improvement efforts to show results, added to the time it takes data to show up in the outcome-based quality improvement (OBQI) system, HHAs don't have any time to lose in revving up their QI programs for P4P implementation.

Improve Your OASIS Accuracy

Agencies need to make sure they are collecting patient outcome information in OASIS accurately, Teenier advised. Train your clinicians on the tool and implement a peer mentorship program for new staff.

Have manager clinicians review OASIS assessments for accuracy,  Teenier urged. You may want to have OASIS specialists perform the assessments to ensure the highest quality data.

Tackle this challenge: HHAs need to emphasize to clinicians that the answers to all the OASIS questions are important, even if the items don't contribute to the case mix and thus the patient's payment level, Teenier stressed. Staff need to understand how the OASIS questions they answer affect the OBQI measures generated for your agency.

Other P4P tips Teenier offered include:

• Know your data. Look at your OBQI data in comparison to the state and local numbers provided. "That's what you'll be measured on" under P4P, she cautioned. Find the top three or four areas that are trouble spots, then perform very targeted clinical record reviews to find the problems contributing to those weak outcome scores.

Push your software vendors to furnish reports with outcomes data that you need ongoing, she added.

• Generate an action plan. Your action plan to improve an outcome must have steps that include specific details, a timeline with deadlines for the respective steps, and a person who is responsible for the steps. Following up to see how the plan is working is crucial.

A successful action plan will require prioritization from management. If you don't ask about it, the plan may fall to the wayside. "Whatever you stress is what they monitor," Teenier noted.

• Improve clinical-finance communication. Make sure your finance department, clinical managers and field staff have open communication about the outcome measures and the effect they have on payment once a P4P system is finalized.

• Utilize the QIOs. Take advantage of the free QI resources the government offers through the Quality Improvement Organizations. Access QIO information, including an action plan tool, at www.medqic.org.