Home Health & Hospice Week

Plus: A second star rating for patient surveys is on deck for January.

If you’ve been hoping Medicare’s star rating initiative for home health agencies would get pushed off, you’re out of luck.

The Centers for Medicare & Medicaid Services is planning to post star ratings, on a scale of 1 to 5, for home health agencies starting in July, a CMS official reminded HHAs in the May 6 Open Door Forum for home care providers. Agencies had a chance to preview their ratings and submit review requests in April (see Eli’s HCW, Vol. XXIV, No. 13).

In flux: CMS continues to consumer test the exact language it will use on the Home Health Compare site to describe the ratings, CMS said in the forum.

Remember: CMS is basing the star ratings on these nine quality measures (three process, six outcomes):

• Timely Initiation of Care

• Drug Education on all Medications Pro-vided to Patient/Caregiver

• Influenza Immunization Received for Current Flu Season

• Improvement in Ambulation

• Improvement in Bed Transferring

• Improvement in Bathing

• Improvement in Pain Interfering With Activity

• Improvement in Shortness of Breath

• Acute Care Hospitalization.

Unchanged: Most agencies will fall in the 3- and 3.5-star categories, the CMS official confirmed. HHAs have protested that grouping as labeling most agencies as subpar in the minds of referral sources and potential patients (see Eli’s HCW, Vol. XXIV, No. 2).

The star ratings won’t be the only new thing on Home Health Compare. CMS is adding two new quality measures to the site in July as well — rehospitalization during the first 30 days of home health, and emergency department use without hospital readmission during the first 30 days of home health.

And just to confuse matters further, CMS is going to start assigning a separate star rating to HHAs on HH Compare, based on CAHPS patient survey data. Those ratings will begin in January 2016, CMS notes on its star rating website.

Keep Straight 2 Different Star Ratings

Two names: CMS will call the star rating based on the nine quality measures the “Quality of Patient Care Star Rating,” and will call the CAHPS-based star rating the “Patient Survey Star Ratings,” the agency explains. “Many stakeholders have proposed that the patient experience of care measures, based on the HHCAHPS survey data, be reflected in the star ratings,” CMS claims.

CMS will assign an overall “survey summary star” rating, plus will assign stars to each of these four measures, it explained in a May 7 Special Open Door Forum about the new initiative:

• Care of Patients

• Communication Between Providers and Patients

• Specific Care Issues

• Overall Rating of Care Provided by HHA.

The breakdown of the survey summary star ratings is a bit wider, with 39 percent of agencies achieving 4 stars in recent analysis and 28 percent receiving 3 stars. Only 14 percent received 5 stars. (For more details about survey summary star ratings, see a future issue of Eli’s Home Care Week.)

Other issues addressed in the forum include:

Bundling. If providers are turning to you to seek payment for services that are not bundled into the HHA PPS rate, direct them to the consolidated billing list at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/coding_billing.html under “Downloads.”

In the forum, a psychotherapy provider re-ported receiving denials from its Medicare Admini-strative Contractor for therapy services furnished to patients in their homes.

The denials should occur only if the pro-vider is billing services with codes that are identified on the home health bundling list, explained CMS’s Randy Throndset in the forum. For therapy, that generally includes only physical and speech language pathology codes, noted CMS’s Wil Gehne.

Providers can dispute incorrect denials by referencing the list, Throndset confirmed.

CAHPS. You can see new CAHPS data on Home Health Compare from the April 15 refresh, said CMS’s Debra Dean Whittaker in the ODF.