OASIS Alert

Risk adjustment stands in the way of some NQF-approved measures.

Riddle: What started with 100, moved to 28 and ended at 15?
 
Solution: Home health quality measures NQF members think you should report.

Following months of discussion and voting, the National Quality Forum has endorsed 15 quality measures for home health agencies. But the Centers for Medicare & Medicaid Services has declined to include all of them in Home Health Compare - at least for now.

CMS announced last December it will remove four measures that NQF didn't endorse, or even propose, for public reporting. The drop-ped measures address upper body dressing, bathing, toileting and confusion frequency. Since then, HHAs have been waiting for results of the NQF vote to see which quality measures CMS would add, of the 28 proposed for home health  (see Eli's OASIS Alert, Vol. 5, No. 10).

The issue: Seven of NQF's measures endorsed in the recent vote already are included in Home Health Compare, CMS' online outcomes comparison Web site. But eight measures have never been made public before. The new 15-measure set NQF members endorsed constitutes "an improvement over existing Home Health Compare measures," believes Stephen Connor, vice president of the National Hospice and Palliative Care Organization.

The conclusion: However, CMS has decided not to adopt all 15 measures. Instead, CMS says it will adopt 10 measures the NQF endorsed Feb. 7. CMS will include these measures in the fall revision of Home Health Compare, the agency says. But it won't add four outcome-based quality monitoring measures, otherwise known as adverse events.

"We will not post four of the OBQMs in their present format," a CMS official tells Eli. "We will revisit how we can present the data on those in a way useful to consumers." And that probably won't happen any time soon.

The rejected adverse events on pressure ulcers and different types of emergent care aren't risk adjusted, notes John Beard, president of Alacare Home Health & Hospice in Birmingham, AL. As such, they could reflect an agency's patient population more than its quality of care.
 
In addition to the OBQMs, CMS also is waiting to include a measure on improvement in status of surgical wounds. The agency wants to "take a closer look at the risk adjustment before we go live with it," the CMS official says. The measure appears to be on a faster track than the OBQMs, however, because it already has a risk adjustment model. "We plan to add Improvement in Status of Surgical Wounds in a future release," CMS announces on its Web site.

NQF plans to update the home health measures every three years after endorsing the final measures this year, says spokesperson Phil Dunn.

Don't miss: The next update to Home Health Compare on March 3 will include data from December 2003 through November 2004.

Editor's Note: Information on the Home Health Compare changes is at www.cms.hhs.gov/quality/hhqi/Endorsement.pdf.