Home Health & Hospice Week

Experts express misgivings about proposed measures. Some of the new home health quality measures the National Quality Forum proposes could place a whole new workload on your shoulders - and some are just plain misleading, experts argue.

Here are some of the top measures experts find problems with:

Comprehensive Geriatric Assessment. Under this new measure, home health agency admission assessments would have to document each of these nine components: medications, functional status, cognition, affect, gait and balance, nutrition, social support, hearing, and vision, according to the proposal.

The burden of this item depends entirely on how it is implemented, predicts Bob Wardwell with the Visiting Nurse Associations of America. If the Centers for Medicare & Medicaid Services takes a flexible approach, a normal HHA comprehensive assessment could be viewed as taking these nine areas into account.

But a more rigid approach could force agencies to fill out reams of added paperwork on each of these nine areas, worries Brian Ellsworth with the Connecticut Association for Home Care. Without more details, there's no way to know which path CMS will take.

OBQM measures. The seven outcome-based quality monitoring measures, which track adverse events, are inappropriate for use as publicly reported quality measures, Ellsworth protests. CMS defines OBQM events as potential areas for investigation - for example, emergent care for hypo/hyperglycemia may have been unavoidable, or discharge to the community needing wound care or medication assistance may have been forced by a patient no longer being homebound.

OBQM measures "are indicators of a potential problem, not reflection of an actual problem," Wardwell stresses. "But once you publish it and give someone a score," agencies will be judged on factors out of their control or that are irrelevant, he says.

Hospitalization/emergent care. Like OBQM measures, the current Home Health Compare, OBQI-based measures on acute care hospitalization and emergent care aren't good indicators of an HHA's quality, Ellsworth insists. "They are misleading and inaccurate," he charges.

Many questions remain on other measures NQF proposes, largely because few details have been nailed down on them, Wardwell says. For example, guidelines on which measures apply to whom, because some of the measures address hospice care, are necessary for full evaluation.