OASIS Alert

OASIS results don't mesh with claims data.

Home care veterans weren't surprised by a new study's results showing home care in a positive light, but the feds may have been.

The quality improvement focus of home health agencies this year is to reduce acute care hospitalizations. This Home Health Compare publicly reported outcome measure has remained steady at 28 percent for the last three years. But at least the rate hasn't increased.

PPS Didn't Change Hospitalizations

In a document issued in January, the HHS Office of Inspector General reported on the effect of the home health prospective payment system on hospital readmissions and emergency room visits of Medicare beneficiaries discharged to home care.

In comparing pre-PPS and post-PPS data, the OIG found no increase in the number of home care patients readmitted to the hospital.

The rehospitalization rate remained at 47 percent from 2000 (before PPS took effect) throughout the next three years of PPS, the OIG reports. The ER visit rate increased slightly from 29 percent in 2000 to 30 percent by 2003. The number of avoidable adverse events also remained very low for home health patients.

How the OIG calculated: The difference between the OIG numbers and outcomes reported on Home Health Compare result from variations in how the calculations are done. The OIG included in its study only patients who were hospitalized within 30 days before admission to home care; it included only patients who had no home care episode for at least 60 days before start of care; and it counted rehospitalizations occurring not just in the 60 day episode, but in the 30 days following the episode.

"We extended the length of time to capture any beneficiary whose hospital readmission or emergency department visit occurred in the month immediately following the conclusion of his or her home health services," the OIG says.

Because PPS includes a financial incentive to keep the number of visits an agency makes to a patient lower than under past payment systems, Medicare officials were concerned that more patients would return to the emergency room or hospital for care. Clinicians expressed no surprise, though: "When a patient needs care, you care for them, no matter which payment system you're under," quality improvement staffer Jackie Wigent with HHA Home Care of the Grand Valley in Grand Junction, CO tells Eli. 
 
Opportunity: Use the OIG information in your quality improvement efforts. Although overall rehospitalizations haven't increased, a few diagnoses showed an increase of 4 to 5 percent in home care patients rehospitalized. These include renal failure, multiple sclerosis and pulmonary disease. This information could help you in your efforts to reduce acute care hospitalizations, experts suggest.

In its response to the report, the Centers for Medicare & Medicaid Services agreed the OIG should continue monitoring rehospitalization and ER visits for home care patients. CMS also reported its plans to link data from home health agency claims to OASIS data. 

Note: The OIG report is at www.oig.hhs.gov/oei/reports/oei-01-04-00160.pdf.