Home Health & Hospice Week

Plus: Vaccination measures raise questions.

The risk adjustment CMS uses for Home Health Compare may become a lot more important to you when your star rating depends on it.

Six of the 10 measures the Centers for Medicare & Medicaid Services proposes to use to calculate agencies’ scores in the five-star system are risk adjusted, noted physician Alan Levitt with CMS in the agency’s Dec. 17 special Open Door Forum on the proposal.

The six risk adjusted measures are:

1. Improvement in Ambulation
2. Improvement in Bed Transferring
3. Improvement in Bathing
4. Improvement in Pain Interfering With Activity
5. Improvement in Dyspnea
6. Acute Care Hospitalization.

You can dive into the details of risk adjustment at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIQualityMeasures.html — click on the “Risk Adjustment Models – OASIS” zip file in the “Downloads” section, suggested Gene Nuccio with CMS contractor University of Colorado.

The four measures that are not risk adjusted are process measures, Levitt noted: Timely Initiation of Care; Drug Education on all Medications Pro-vided to Patient/Caregiver; Influenza Immunization Received for Current Flu Season; and Pneumococcal Vaccine Ever Received.

Other issues raised on the forum include:

• Value-Based Purchasing. One caller asked if CMS is considering the same measures for use in the upcoming value-based purchasing system. “That’s certainly a reasonable comment,” noted CMS’s Mary Pratt in response.

But keep in mind that CMS looked at these measures “because they allow us to formulate a comparison between agencies,” Levitt said. VBP measures “may or may not have that same purpose.” Under a VBP program, “we’d have to look at the measures again — all the measures,” he added.

• Vaccination items. Two of the 10 proposed measures address vaccinations — Influenza Immunization Received for Current Flu Season and Pneumococcal Vaccine Ever Received. Those items are underwent some significant changes in the transition to OASIS-C1 (see Eli’s HCW, Vol. XXIII, No. 44-45). One caller expressed concerns about the change’s impact on scoring.

CMS still can collect comparable information from the two OASIS items and can combine the two into a measure that is consistent across the transition, a University of Colorado rep assured.

One agency questioned the prominence of the vaccination items, since “95 percent of the time” patients get the shots in another care setting.

Remember that the revised OASIS-C1 items are asking home health agencies to verify that patients receive the vaccinations, not to administer the vaccine themselves, said Colorado’s David Hittle in the forum. 

“From a federal standpoint, vaccination is considered important in this patient population,” Levitt said.

• Eligibility concerns. One caller voiced the fear that under the new system, agencies would hang onto patients longer in order to boost their outcomes and, thus, star rating score. That could lead to problems with long-stay patients’ eligibility.

“We’re always looking at unintended consequences,” Levitt responded.