Home Health Coding and OASIS Expert

Published on Fri Jun 12, 2015 PDF

Reimbursement and outcomes aren’t the only measures that depend on your OASIS answers.

The countdown is on — in just a few short weeks, your star ratings will be publicly available. And you can expect another round to follow in the beginning of 2016.

Get ready: The Centers for Medicare & Services will post star ratings for nine of the 27 currently reported measures on Home Health Compare. CMS dropped “Pneumococcal Vaccine Ever Received” from its initial proposal.

Home health agencies still have plenty of complaints about the measures CMS retained for its “quality of patient care star ratings” program. For one, “an agency’s ability to stabilize patients is not taken into consideration in the rating system, though it’s often the desired and only outcome for certain patients,” protests benchmarking data vendor Strategic Healthcare Programs.

HHAs have long bemoaned being held responsible for hospital readmissions, since so many factors influencing the event are out of their control. 

Another problem is CMS’s permanent one quarter delay to publishing data, due to its need to synch its Home Health Compare scores and star ratings, Santa Barbara, Calif.-based SHP notes on its website. “Hospitalization data, the #1 focus for home health and hospitals, will be a whopping nine months old,” the company points out. “On the eve of value-based purchasing, when quality performance has never been more critical, availability of the public data used to evaluate care takes a step backward. This is progress?”

And agencies continue to criticize the clumping of scores in the 3 and 3.5-star categories.

“The objective of the star rating is to help consumers choose high quality providers, but CMS has its work cut out for it, as they’ll have to educate consumers on how an ‘average’ score might actually equate to high quality care,” SHP insists. “The system is confusing and misleading. Star ratings are seen everywhere these days, and never does a 3-4 star rating signify ‘the best,’ so how will consumers be expected to use this system in a meaningful way?”

Take action: When trying to prioritize the many needs of your home health agency, you should put OASIS training at the top of the list, experts advise.

Why? Not only does OASIS set your patient’s reimbursement and outcomes, but it now will contribute heavily to your star rating.

“Now, more than ever, the OASIS data must be accurate and reflect a true TOTAL picture of the patient,” urges consulting firm Select Data in an analysis of the star rating system. “Make certain agency clinicians understand how to answer the OASIS questions in relation to the patient’s condition and needs as well as the specific OASIS Conventions,” says the Anaheim, Calif.-based firm on its website.

Know What’s Being Measured

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.

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.

Note: For more articles about running a successful home health agency, subscribe to Eli’s Home Care Week: www.codinginstitute.com/newsletters/eli-home-care-week.html.