Home Health & Hospice Week

You’ll get an advance look at your stats this month.

Four new quality measures went up on Home Health Compare back in January, and now one delayed measure is ready to catch up.

Reminder: The Centers for Medicare & Medicaid Services posted Assessment-based Percent of Residents or Patients with a Pressure Ulcers that Are New or Worsened (Short Stay); Assessment-based Drug Regimen Review Conducted with Follow-Up for identified Issues; Claims-based Medicare Spending Per Beneficiary-PAC HH QRP; and Claims-based Discharge to Community-PAC HH QRP at the beginning of the year (see Eli’s HCW, Vol. XXVIII, No. 7).But it held off on publishing a Potentially Preventable 30-Day Post-Discharge Readmissions measure, saying it needed more testing.

Now CMS has concluded its testing of the IMPACT Act-sparked measure, and is ready to post it on Home Health Compare in October, according to a new fact sheet and frequently asked question set from the agency. The new cross-setting measure will also appear on the Compare sites for skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals.

CMS finalized the measure in its 2017 HH Prospective Payment System final rule issued in October 2016 (see Eli’s HCW, Vol. XXV, No. 39-40).

“Because potentially preventable readmission rates are relatively low, CMS conducted additional testing to ensure that the measure reliably assesses the performance of SNFs, IRFs, LTCHs, and home health agencies (HHAs) on quality,” the agency explains in the fact sheet released May 30.“We postponed publishing these measures while we were conducting this additional testing.”

CMS will publish the provider’s potentially preventable readmission (PPR) rate and its performance category — “whether the provider’s rate is ‘better than the national rate,’ ‘worse than the national rate,’ or ‘no different than the national rate,’” the agency explains. “CMS will also publish confidence intervals, measures of the uncertainty surrounding the provider’s rate, which are used as the basis for the performance categories.”

CMS did make some changes based on its testing. “We have refined the statistical method for calculating the confidence interval and for assigning the provider to a performance category,” it says. “This refinement will better align the PPR measures with ... readmission measures used in other programs.”

Home Health Compare already displays data for some hospitalization and emergency room measures, including “How often home health patients had to be admitted to the hospital” (Acute care hospitalizations) and “How often home health patients, who have had a recent hospital stay, had to be re-admitted to the hospital” (Rehospitalization during the first 30 days of home health). The latter measure is displayed with three categories — “Worse than expected,” “Same as expected,” and “Better than expected.”

With those measures in place, why add the PPR measure? For one, the IMPACT Act of 2014 requires it. But also, “PPRs are a subset of all-cause, unplanned readmissions,” CMS explains in the FAQs. “Because all-cause, unplanned readmissions among the Medicare population are common and costly occurrences, focusing readmission measures on those readmissions that are more likely to be preventable with high-quality care may allow providers to focus on conditions considered more actionable.”

CMS uses diagnosis codes to determine whether a hospital readmission is potentially preventable. If the patient has a diagnosis in one of four groups — Inadequate management of chronic conditions; Inadequate management of infections; Inadequate management of other unplanned events; or Inadequate injury prevention, the readmission qualifies, CMS explains in the FAQs.

Watch for: “Home health agencies can expect to see their Preview Reports for the October 2019 Compare refresh, including the Potentially Preventable 30-Day Post-Discharge Readmission measure, in their CASPER folders on June 24,” the National Association for Home Care & Hospice says in its member newsletter.

Note: The fact sheet is at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Fact-Sheet-for-Potentially-Preventable-Readmission-Measures-for-the-Post-Acute-Care-QRPs.pdf and the FAQs at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/FAQs-for-Potentially-Preventable-Readmission-Measures-for-the-Post-Acute-Care-QRPs.pdf.