Home Health & Hospice Week

New OASIS-based measures likely to see quick implementation. The National Quality Forum may be making home health agencies an offer they can't refuse regarding quality measures.

NQF spells out its 28 proposed quality measures for home health in a report recently posted to its Web site. The list is almost the same as the 29 measures NQF's home health steering committee recommended after a July meeting (see Eli's HCW, Vol. XIII, No. 27, p. 211). It includes seven measures already publicly reported under Home Health Compare.

NQF dropped "ADL/Rehab Potential and No Therapies" from the list because the developer withdrew it, the report explains. The developer likely withdrew it because it was the only measure out of a 22-item set to be chosen for inclusion.

Another change is that NQF decided to make the entire list of 28 measures recommended for public reporting. Previously, the NQF home health steering committee had recommended designating the outcome-based quality monitoring (OBQM) items, i.e. adverse events, for internal quality improvement purposes only.

NQF is now collecting comments from the public and its members on the measures. NQF members will vote on a revised ballot of measures in November and December, and NQF will forward its final recommendations to the Centers for Medicare & Medicaid Services at the beginning of 2005.

CMS has noted in an open door forum that it isn't required to automatically adopt the measures NQF proposes. But the agency will have to report on why it doesn't adopt them, according to law.

That means CMS is likely to adopt quickly the new measures based on OASIS data - the seven OBQM measures plus Improvement in Status of Surgical Wounds, Improvement in Urinary Inconti-nence, Improvement in Dyspnea, and Discharged to the Community. Relatively quick implementation is probable because the data-gathering and reporting systems already are in place for those measures, notes Bob Wardwell with the Visiting Nurse Associations of America. If CMS didn't adopt the OASIS-based measures, it would have to justify why in a public report.

The agency may hold off a while on implementing the 10 measures not based on OASIS data, predicts Brian Ellsworth of the Connecticut Association for Home Care. Some major data collection and reporting overhauls will have to take place to make these measures, many of them process-based, possible.

With CMS' other burdens required by the Medicare Modernization Act, namely implementing the prescription drug benefit, the agency may easily justify why it isn't ready to adopt new non-OASIS measures. Major OASIS Overhaul Ahead But CMS won't be able to put off the non-OASIS measures forever. The changes to capture data for those measures are likely to add a significant new burden to HHAs' workloads, Wardwell and Ellsworth worry.

The NQF report implies OASIS would have [...]