Medicare Compliance & Reimbursement

Number of process-based measures could replace patient outcomes.

An organization few people have heard of could be deciding the fate of home health agencies' Home Health Compare rating - and whether a huge new burden will be placed on HHAs.
 
The National Quality Forum has tentatively agreed on 29 new quality measures for home health agencies - 22 for public reporting via Home Health Compare and seven for internal quality improvement purposes. The Centers for Medicare & Medicaid Services and HHAs will have to adopt the quality measures if the forum finalizes them under its consensus-building procedures, according to NQF spokesperson Phil Dunn.
 
NQF is an organization whose stakeholder members discuss and endorse quality measures for health care providers. They have already done so for provider groups such as hospitals and nursing homes, Dunn explains.
 
NQF doesn't develop the measures, but rather accepts submitted measures. For the home care measures, CMS, the National Hospice and Palliative Care Organization and Assessing Care of Vulnerable Elders were among those who submitted measures for consideration.
 
In a July 21 meeting in Washington, NQF's home health steering committee discussed the submitted measures and recommended ones for endorsement. Next month, NQF will compile its recommendations in a report, issue it, and call for public comment on them, Dunn tells MLR.
 
At the end of the process, NQF will endorse the finalized measures, which CMS and HHAs will be required to adopt, Dunn says. A final report will go to Congress in February or so, says a CMS spokesperson.
 
But CMS and NQF appear to disagree on whether Medicare really has to adopt the endorsed measures, says Bob Wardwell with the Visiting Nurse Associations of America. "The 64-dollar question is how many of the new measures will be required by Medicare," says Wardwell, a former CMS top official. "NQF and CMS seemed to be saying different things."
 
And most agencies have no idea that their quality improvement workloads and ratings are hanging in the balance. Whether it means to or not, NQF "is flying under the radar," says Brian Ellsworth of the Connecticut Association for Home Care.
 
If NQF endorses and CMS adopts many of the existing OASIS-based measures plus the 11 new process measures, it could add up to "a big new burden on HHAs," Wardwell worries. If CMS decides to add all the new proposals on top of the existing quality measures, agencies will pay the price.
 
Editor's Note: A description of the home care project is at www.qualityforum.org/txhomehealthNQFprojsummaryFINAL+SCroster.pdf.