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. Once patient outcomes go out in newspaper ads and on the Web, patients, referral sources, the press and many other groups will be perusing them. Unfortunately, what they see could be misleading about an agency's quality of care, protests Carol Rodat with the Home Care Association of New York State.

CMS Using Bad Data, Critics Say  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 [...]