Home Health & Hospice Week

Home care workers have a new guidebook for collecting and using OASIS C data to improve process quality, but don't expect it to clearly explain how smaller agencies can take advantage of  quality improvement tools.

The Centers for Medicare & Medicaid Services has released the Process-Based Quality Improvement (PBQI) Manual (see related story, p. 161). The manual is the agency's fourth resource designed to help agencies meet CMS's quality improvement standards. The 47-page guidebook contains three chapters and two appendices that detail how process quality measures are reported and offer step-by-step recommendations for how agencies can use their findings to spot and remediate problems.

Good news: "This manual should be very useful for agencies," says Rebecca Friedman Zuber, a regulatory consultant in Chicago. The resource includes factual information about how CMS will calculate the various measures, which will help agencies explain the measures to their clients and referral sources. Also, the manual includes a better and more convincing explanation of CMS's attitude toward the activities being measured. "There has been lots of panic out there about agencies needing to achieve 100 percent on everything," and CMS hasn't been able to calm those fears, Zuber notes. The manual's sample reports will help agencies better understand CMS's goals.

Bad news: While PBQI will be a handy resource for larger, more sophisticated agencies, it may leave smaller operations in the dark, Zuber worries.

"CMS hasn't done enough training to help less sophisticated agencies either understand the value of these activities or feel confident performing them," she notes. And smaller agencies are unlikely to have the budgets necessary to engage in these activities on an ongoing basis.

Better: Quality Improvement Organizations used to work with smaller agencies to train them on the Outcome-Based Quality Improvement (OBQI) Manual. A similar program should be "offered on  an ongoing basis if CMS hopes to get a large number of agencies really involved in performance improvement, particularly before incentives like pay for performance are implemented," Zuber recommends.

Though PBQI isn't perfect, it does show that CMS is committed to improving quality and developing tools agencies can use as part of that effort, she says.

And PBQI isn't the only sign. CMS is currently revising OBQI and Outcome-Based Quality Monitoring (OBQM) manuals to better assist agencies as they work to improve the quality of care.

Resource: Access the PBQI manual online at www.cms.gov/HomeHealthQualityInits/Downloads/HHQIOASIS-PBQI.pdf.