Home Health & Hospice Week

Before you get too grateful for the help Quality Improvement Organizations are offering home health agencies in the pilot project that will publicly compare patient outcomes, take a close look at what QIOs are allowed to do with your information.

The Centers for Medicare & Medicaid Services takes great pains to distinguish the role of QIOs versus state survey agencies in documents recently posted to CMS' home health quality improvement Web site. "The QIO mission does not include inspection and enforcement around regulatory standards," but rather promotion of "improvement and excellence in care," CMS insists.

Nevertheless, any information reported by the HHA to the QIO must be disclosed to surveyors who require the info "to carry out a function mandated by State law," CMS reveals. And the QIO is required "to report to State agencies ... in situations where there is a need to protect against a substantial risk to the public health," CMS says.

The problem, says attorney Virginia Caudill with Indianapolis-based Gilliland & Caudill, is that the standard QIOs must use to determine when reporting is necessary is no standard at all.

The supposed risk to public health "might involve occurrences which any individual citizen would find unacceptable" or "might be understood as unacceptable by someone with clinical experience," CMS says. That covers just about every situation that might arise and offers very little protection to HHAs handing over information to these organizations, Caudill protests.

The QIOs will use their own judgment in determining whether situations qualify for that risk, CMS sets out in the HHQI document. If you have reasonable folks at your state's QIO, that will work out great, Caudill notes. If you have staffers who are as zealous as some state surveyors, you could wind up on your state survey agency's problem list.

QIOs first will urge HHAs to self-report anything they perceive to be such a risk, CMS says. If the HHA refuses, the QIO will go straight to surveyors itself.

"No home health provider should ever be naive about where and how their information travels," warns attorney Deborah Randall with Arent Fox Kintner Plotkin & Kahn in Washington. "Agencies ought to be protective of their own reputations."

If taken to its extreme, use of QIOs could become a backdoor path to more regulation of HHAs, fumes Caudill. And worse, "it's regulation without checks and balances."

While consorting with QIOs could land you on surveyors' hit list, it isn't going to help get you off of it, at least not right away. CMS stresses that participation in QIO programs won't impact survey process or findings. In fact, CMS warns agencies against using QIO relationships to "shield" information from surveyors.

That means HHAs "have everything to lose and nothing to gain" survey-wise, judges Caudill.

In addition to delineating QIO versus surveyor roles, CMS also emphasizes that the QIO's job will be to promote awareness of the HHQI project to publicly compare home health patient outcomes. QIOs will do so "by conveying the message that some home health agencies do better than others in regards to quality measures."

If you fall on the short end of the outcomes scale, QIOs will not be your best friend as they use the media and work with hospital discharge planners and community organizations to spread the word about your poor performance.

Caudill notes that agencies have no recourse to dispute the outcome findings or their meanings. "When the government can say whatever it wants to whoever it wants whenever it wants, that's a big problem," she argues.