Medicare Compliance & Reimbursement

The home health quality initiative will be hitting the Web and local newspapers in late October, and that leaves home health agencies crying foul over misleading data.

The national rollout of the public patient outcome comparison will look much the same as the eight-state pilot program that launched in May. The initiative will post the same 11 patient outcomes on the Centers for Medicare & Medicaid Services Home Health Compare Web site.

And three of those outcomes will be highlighted in newspaper advertisements across the country when the program launches. CMS plans to run at least one ad per state featuring 40 to 50 HHAs' outcomes, reports the National Association for Home Care & Hospice.

CMS says it will send a preview of the HHQI data to agencies' QIES mailboxes sometime between Oct. 1 and Oct. 21, when the initiative is scheduled to kick off.

The Home Health Compare Web site, available at www.medicare.gov, will include one significant change, NAHC notes. Visitors now will be able to search by the number of beneficiaries served by an agency in a certain zip code. CMS added this new search function after Phase I participants complained that numerous agencies that didn't actually serve the searcher's geographic area came up in the search.

The new search option will display agencies with the highest number of beneficiaries served in the zip code at the top and the lowest at the bottom, explains NAHC's Mary St. Pierre.

"It won't eliminate the problem" of wrong agencies showing up in a search, but it will help identify those that really do cover the area by showing whether they have a substantial number of beneficiaries served in the zip code, St. Pierre expects.

In New York, the state has a popular program that keeps beneficiaries out of nursing homes with home care. Those patients have chronic, long-term conditions and generally aren't expected to improve, Rodat points out.

Under the HHQI program, New York HHAs that serve those types of patients have lower outcomes than other agencies, and thus look like they are providing a lower quality of care, Rodat tells Eli. The risk-adjustment CMS uses in the calculations doesn't compensate for this population, she maintains.

About 40 percent of New York agencies listed on Home Health Compare serve only this long-term, chronic population, and their outcomes look poor compared to the agencies that serve a mix of traditional Medicare patients and long-term patients, Rodat laments. "It skews the outcomes," she says.

Rodat expects other states with similar programs for long-term care will see similar results.

Another problem with HHQI is that the data simply isn't reliable enough to be used for public reporting, Rodat argues. Clinicians are still very inconsistent in how they collect OASIS data and interrater reliability between assessments is low, she claims. That's the case even in New York, where the industry has been using OASIS for seven years (since it was part of the OASIS demonstration project).

Finally, because the patient is in the home and not in an institutional setting, HHAs have very little control over some of the outcomes measured by HHQI, Rodat says. For example, the management of oral medications outcome can be influenced by how physicians prescribe medications, whether the patient takes old meds without permission, if the patient takes someone else's meds, etc., she notes - all conditions largely out of an HHA's hands.

More examples are the acute care hospitalization and emergent care outcomes, points out Bob Wardwell with the Visiting Nurse Associations of America. "They pick up lots of coding errors and situations that are not reflective of agency care problems," Wardwell says.