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Medicare Compliance & Reimbursement

Home Health:

HHAs Brace For Scrutiny Of their Patient Outcomes

Published on Thu Oct 16, 2003

Bathing, ambulation, oral meds in the national spotlight. 

The Oct. 21 deadline for national rollout of the home health quality initiative may be pushed back, but it's still likely to be only a matter of days until the public is comparing home health agencies' patient outcomes.

Physicians, discharge planners, patients and the public at large will be able to log onto Medicare's Home Health Compare Web site to look at patient outcomes soon after the original Oct. 21 launch date, a Centers for Medicare & Medicaid Services spokesperson said in the Oct. 7 Open Door Forum for home health.

The delay is due to the difficulty in coordinating both CMS Administrator Tom Scully's and Department of Health and Human Services Secretary Tommy Thompson's schedules so they can appear at the kickoff, not to the readiness of the Web site.

As part of the project's national launch, CMS will place about 65 paid advertisements in newspapers across the country, the CMS official said. The ads will compare three outcomes among area home health agencies - getting better at moving and walking around, getting better at taking medicines correctly by mouth, and getting better at bathing.

Those are the same three outcomes featured in ads for the pilot HHQI project, which ran for eight states beginning in May. On the Home Health Compare Web site, consumers can look at all 11 of an agency's publicly reported patient outcomes once the project starts.

The ads also will explain briefly what home care is and will refer readers to the Home Health Compare Web site for more information.

Expect to Find Errors in Preview Data 

Agencies will have a chance to see their data before the public does. CMS already has put the HHQI reports in a folder in HHAs' QIES mailboxes.

From the OASIS system welcome page, CMS' Lori Anderson instructed in the Oct. 3 satellite broadcast, HHAs should:

  • click on "online reports,"

  • enter their usual user ID numbers and passwords on the CASPER page,

  • click on the "folders" button at the top of the CASPER welcome page, and

  • click on the folder that begins with an asterisk (*), which will contain the preview data for Home Health Compare.

    If an HHA manager finds an error in her demographic information - agency name, address, phone number and services provided - she must submit a request in writing to her state OSCAR/ASPEN coordinator to update her records, CMS' Mary Weakland said in the nearly two-and-a-half hour HHQI broadcast. The Home Health Compare Web site pulls its demographic data from those state-maintained survey records.

    CMS sent state survey agencies a memo instructing them to make the updates, even if they're not related to a survey. Agencies can refer reluctant state agencies to the Sept. 11 memo to make sure their data is shown correctly in the site after the next update, a CMS official said in the Open Door Forum.

    Demographic information will be updated monthly on Home Health Compare, CMS' Karen Pace noted in the broadcast. However, CMS will update the outcome figures themselves only on a quarterly basis, because the pilot project showed that outcome statistics generally didn't change significantly from month to month.

    Every time CMS updates the outcome figures, it also will move up the 12-month time period included in the public reporting, Pace explained. With the launch that starts this month, patients with episodes between June 2002 and May 2003 will be included. When the first quarterly update takes place in January, episodes from November 2002 through October 2003 will be included. After that, the 12-month time period will move up by quarters.

    Are Some Outcomes Exempt? 

    Not every patient's or agency's outcomes will necessarily show up on the site, however. If an agency has fewer than 20 episodes in the year under consideration for a certain outcome, Home Health Compare will inform users there are too few episodes to calculate a publicly reported figure.

    That threshold was set to ensure agencies with small populations don't have misleading numbers reported, CMS said. It also helps ensure patient privacy.

    If an outcome's figure is under 5 percent or more than 95 percent, the site won't show a specific figure - it will just say it's over or under that number. That's also to ensure patient privacy, CMS said.

    Finally, agencies with less than a year of data will still show up on Home Health Compare. Once an agency has compiled six month's worth of patient outcome data, the site will display its outcomes with a note explaining the shortened time frame, Pace said.

    To see the archived HHQI broadcast on the Web, go to http://cms.internetstreaming.com. More details on the initiative are at www.cms.hhs.gov/quality/hhqi/default.asp, including examples of the print ads from the Phase I pilot project.

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