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Home Health & Hospice Week

Quality:

Get To Know Your New HCI Components

Published on Fri Nov 12, 2021

Say goodbye to current hospitalization measures, and hello to a new ‘potentially preventable’ hospitalization measure.

How you are judged for your patients’ hospitalizations will change in just over a year.

Old way: The HH Quality Reporting Program currently uses Acute Care Hospitalization during the First 60 Days of Home Health (NQF #0171) and Emergency Department Use Without Hospitalization During the First 60 Days of Home Health (NQF #0173), both of which are based on claims data.

New way: Come January 2023, The HHQRP will “replace them with the Home Health Within-Stay Potentially Preventable Hospitalization claims-based measures,” the Centers for Medicare & Medicaid Services says in the 2022 home health final rule published in the Nov. 7 Federal Register.

“Hospitalizations among the Medicare population are common, costly, and often preventable,” CMS points out in the final rule. How HHAs address key factors associated with hospitalizations from HH, “including how HHAs address chronic conditions present before the HH stay, can determine whether beneficiaries can successfully avoid hospitalizations. Understanding these factors can help HHAs design strategies to address avoidable hospitalizations.”

Why the new measure is better: The PPH measure “assesses potentially preventable observation stays instead of just emergency department use,” CMS highlights. It also “focuses on the subset of inpatient hospitalizations that could be avoided by HHA intervention,” as well as observation stays, the agency adds.

The Measure Application Partnership “agreed that the PPH measure adds value to the HH QRP’s measure set by adding measurement of potentially preventable hospital­izations and observation stays that may occur at any point in the home health stay. No measure in the program currently provides this information,” CMS notes.

Measure validity and reliability testing results “were very strong and showed more robust results than outcome measures previously finalized through rulemaking,” including the outgoing ACH and ED measures, CMS says.

Reasons for the PPHs addressed by this measure include “(1) Inadequate management of chronic conditions; (2) Inadequate management of infections; (3) Inadequate management of other unplanned events; and (4) Inadequate injury prevention,” according to the final rule.

Plus, “planned admissions are not counted in the numerator,” CMS adds.

Some commenters asked CMS to remove observation stays from the PPH measure, but the agency rebuffs the idea. “Addressing preventable observation stays as well as inpatient stays are important aspects of quality improvement based on clinical research showing the trends of observation stays in inpatient settings and an improvement on addressing only ED use in the numerator,” CMS maintains in the final rule. “Observation stays are an important form of hospitalization and in the process of assessing for observation stays, ED use is also captured.”

CMS plans “to submit the PPH measure for NQF endorsement,” the agency adds.

Ahead: HHAs will get confidential feedback reports with data on the new measure in October 2022, said a CMS official in the Nov. 10 Home Health Open Door Forum.

Bid Farewell To Drug Education Measure

In addition to the hospitalization measure swap, CMS will also boot a current QM that is no longer doing the job.

“We are finalizing our proposal to remove the Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care measure from the HH QRP under measure removal factor 1: Measure performance among HHAs is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made beginning January 1, 2023,” CMS says in the final rule.

“HHAs will no longer be required to submit OASIS Item M2016, Patient/Caregiver Drug Education Intervention beginning January 1, 2023,” CMS adds. And “data for this measure will be publicly reported on Care Compare through October 1, 2023, after which it would be removed from the site,” according to the rule.

In response to comments regarding drug safety, CMS responds that “other measures in the HH QRP, specifically the Improvement in Management of Oral Medications measure, adequately addresses this domain of patient safety with respect to medications along with other measures such as the Drug Regimen Review measure.”

Note: More details of the new PPH measure are at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ HomeHealthQualityInits/Home-Health-Quality-Measures.

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