Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services will trumpet home health agency patient outcomes in a "significant number" of newspapers in eight states, CMS says, and affected agencies should use the next few weeks to prepare for the onslaught of public scrutiny.

CMS hasn't determined exactly how many advertisements it will run, but at least two ads will appear in each state involved in the home health quality initiative, said Rob Sweezy, director of the CMS Office of Public Affairs, in a March 27 HHQI open door forum. Some pilot states will see more ads than others, Sweezy noted.

The full-page ads, which will feature only three of the 11 outcomes in the HHQI project, will run a day after Department of Health and Human Services Secretary Tommy Thompson kicks off the pilot with a news conference unveiling the Home Health Compare Web site on www.medicare. gov. Most likely, Thompson won't have time to participate in the kick-off until the end of the month.

Pilot state HHAs have been in high fidgets over the forthcoming numbers, says consultant Maureen Yadgood with North Andover, CT-based Yadgood & Associates. "People are freaked out."

But a data preview available until April 21 should help calm those fears by showing HHAs exactly what will go down in black-and-white in newspapers and on the Web site, Yadgood notes.

CMS has made the preview of the 11 outcomes available on the same system where agencies access their outcome-based quality improvement reports and submit OASIS data. If HHAs have fewer than 20 cases with a certain patient outcome or less than six months of data for that outcome, a number won't show up on the Web site and the agency won't run in the newspaper ads, Lisa Hines, director of the CMS Division of Ambulatory and Post Acute Care, explained in the forum.

HHAs might be confused by the HHQI data because it differs from the information provided in their OBQI reports, warned David Hittle of the Center for Health Services Research at the University of Colorado, CMS' OASIS contractor.

There are two major differences between HHQI and OBQI numbers, even though they use the exact same patient data, he noted. First, the outcome for pain interfering with activity is risk adjusted in HHQI data while it is not in OBQI data.

Second, in an OBQI report the national reference against which an agency compares its numbers is risk-adjusted to take into account an agency's patient case mix. In the HHQI project, the opposite is true - the agency's own numbers are risk-adjusted while the national and state numbers are not.

CMS has provided a conversion worksheet HHAs can use to translate OBQI to HHQI numbers to make sure they match up.

The data used to figure HHQI outcome rates in the pilot project is drawn from calendar year 2002, CMS noted in the forum. It will be updated monthly, so that next month the data will be drawn from February 2002 through January 2003, and so on.

HHAs in the eight pilot states - Florida, Massachusetts, Missouri, New Mexico, Oregon, South Carolina, Wisconsin and West Virginia - may correct both their administrative data and outcomes data following the preview.

But all HHAs nationwide should check out their administrative data - name, office address, phone number, services provided, initial date of certification and type of ownership - which will be on the Home Health Compare site when it launches. Agencies should follow instructions for submitting corrections to the public database, especially for their phone numbers, so potential clients can contact them, Hines instructed in the forum.

If agencies access their data previews quickly, they should have at least a few weeks before the newspaper ads run to formulate their responses to the numbers, Yadgood notes. Now "that they know what they're facing," agencies should arm themselves with appropriate statistics and explanations to build upon favorable numbers or combat not-so-favorable ones, she advises.

HHAs should be prepared to respond to the press and the public as well as their own referral sources and patients, Yadgood adds.

HHQI materials including the conversion worksheet, instructions for accessing the data preview and forum handouts are at www.cms.hhs.gov/quality/hhqi/default.asp.