Home Health & Hospice Week

If your home health agency's patient outcomes for improvement in bathing, ambulation and management of oral medications aren't up to snuff, it could make you very sorry as soon as next month.

The Centers for Medicare & Medicaid Services has decided to feature these three home health patient outcomes in its publicity campaign that will publish outcomes in local newspapers, said CMS chief Tom Scully in a March 17 Open Door Forum for home health. The remaining eight patient outcomes (see chart,) chosen for the home health quality improvement pilot project in eight states will be available for comparison online at www.medicare.gov under a new Home Health Compare section.

The outcome comparison aims to influence the choice of home health provider for patients as well as discharge planners and other referral sources. CMS plans a national roll-out of the project this fall.

The three outcomes chosen for publicity "represent areas that will be familiar and meaningful to consumers," says OASIS expert Linda Krul-ish with Redmond, CA-based Home Therapy Services. And CMS has side-stepped problems HHAs have with the other eight outcomes, Krulish tells Eli.

For example, the urgent care and pain outcomes lack risk adjustment so don't really compare fairly, because serving a sicker patient population would make an agency's outcomes appear worse. HHAs feel they have little control over some patients' confusion frequency outcomes. Agencies have had trouble answering OASIS question MO690, so the accuracy of the data underlying the transferring outcome is suspect. And explaining the improvement versus stabilization concept behind stabilization in bathing will be confusing, Krulish says.

While the outcomes chosen for heightened publicity might be the easiest to understand, that doesn't mean they don't have their problems as well. Some patients, such as those receiving rehabilitation after accidents, strokes or joint replacements, will improve in ambulation and bathing - both activities of daily living, notes Chapel Hill, NC-based clinical consultant Judy Adams with the Larson Allen Health Care Group.

But long-term, chronically ill patients are more likely to decline than improve in these ADLs regardless of HHAs' efforts, Adams points out. That might encourage agencies not to accept such chronic patients, who already have proven less profitable under the prospective payment system.

And the improvement in managing oral medications outcome actually measures very little improvement in the real world, Adams contends. "Many patients can manage their oral meds as long as someone pre-fills medication planners," notes Adams. But under the rules for MO780, the OASIS question on the topic, "improvement in management is not credited when the patient is doing better with their medication, but still requires someone to pre-fill the planners," she says.

Regardless of the outcomes chosen, agencies are uncomfortable with the idea of their care quality being boiled down to 11 outcomes, and then further down to three for public focus, observes Bob Wardwell with the Visiting Nurse Associations of America. It will be their job "to help folks understand what they are - and aren't," says Wardwell, a former CMS senior official.

In the Open Door Forum, CMS officials said agencies in the eight pilot states - Florida, Massachusetts, Missouri, New Mexico, Oregon, South Carolina, Wisconsin and West Virginia - will receive preview reports with their 11 outcomes in the beginning of April. An explanation of the data will accompany the preview reports, along with instructions on how to correct information. The outcomes used in the HHQI project will be calculated differently than the numbers given to HHAs in their outcome-based quality improvement (OBQI) reports.

All HHAs' identifying and contact information will be entered into CMS' Home Health Compare site, but HHQI data will display only for the agencies in the eight pilot states, CMS said.

By mid- to late April, the Home Health Compare Web site will be up and running for those states and CMS will publish the three outcomes in local newspapers. However, notes the National Association for Home Care and Hospice, right now CMS plans to run ads in only one newspaper in all pilot states except Florida and New Mexico, which will have ads in both Spanish and English.

Others topics covered in the call include: