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 [...]
