Outcomes:
REHOSPITALIZATIONS, ER VISITS HOLD STEADY UNDER PPS
Published on Mon Jan 16, 2006
HHAs already hard at work on outcomes.
The feds can find no reason to complain about home health agencies' care quality when they look at hospital and emergency room visit benchmarks.
So concludes an HHS Office of Inspector General report that analyzes rehospitalizations and emergency department visits for home health patients before and after the prospective payment system took effect. "Increases in readmission rates or emergency department visits could indicate poor quality care," the OIG warns in the new report (OEI-01-04-00160).
The OIG found the rehospitalization rate remained at 47 percent from 2000 (before PPS took effect) throughout the next three years of PPS. The ED visit rate increased slightly from 29 percent in 2000 to 30 percent by 2003. The number of avoidable adverse events also remained very low for home health patients.
The study shows "home care is a bargain with decent quality outcomes in spite of ever lowering reimbursement," notes consultant Regina McNamara with LW Consulting in Harrisburg, PA. "The quality ... is still quite high." No Fuzzy Math, Rather Different Calculations These outcome statistics may seem significantly higher than what HHAs are used to seeing, notes Bob Wardwell with the Visiting Nurse Associations of America. In Home Health Compare, the national rehospitalization rate is 28 percent and the national unplanned medical care rate is 21 percent.
The differences are due to the OIG's methodology in counting patients. In forming an overall pool, researchers included beneficiaries who started a new episode and had no home care at least 60 days prior to the start date. Of those, the OIG included only patients who had been discharged from the hospital up to 30 days before admission.
And the rehospitalization or ED visit could occur during the 60-day episode or up to 30 days after the episode ended. "We extended the length of time to capture any beneficiary whose hospital readmission or emergency department visit occurred in the month immediately following the conclusion of his or her home health services," the report explains.
OASIS vs. claims data: OASIS inaccuracies also could account for some of the difference, the OIG notes. OASIS data relies on what agencies record in assessments, while the OIG looked at paid claims data. The Centers for Medicare & Medicaid Services plans to link OASIS and claims data eventually for more accurate patient outcomes, CMS says in a response letter included with the report.
Even though the OIG report numbers differ significantly from the ones agencies usually track for Home Health Compare, they're still useful, McNamara maintains. HHAs can compare themselves to the national benchmark for both sets of numbers, she suggests.
And HHAs will welcome a link between OASIS and claims data, McNamara predicts. OASIS coding mistakes are to be expected. "Agencies should want [...]
