OASIS Alert

If you've figured out how to read the outcome-based quality improvement reports, you're ready for the next challenge - new reports with a third bar and twice as much comparison data.

When you pull up your next OBQI report, don't be surprised to see some changes. The reports - which cover 41 patient outcome measures -now will show your agency's outcome figures for the most recent 12-month period compared both with your agency's results in the prior 12-month period and with the national reference rate.

In May the Centers for Medicare & Medicaid Services released the OBQI Implementation Manual Supplement to explain to home health agencies how to use the new three-bar outcome reports and three-column case mix reports. The new format will allow providers to "evaluate the impact of their quality improvement activities on patientout comes," the report says.

This comes at a time when you're probably already overloaded with change. HHAs are so busy dealing with budget cuts, staff shortages, HIPAA and Home Health Compare that "it's hard to give the level of attention yet more quality data demands," says Bob Wardwell with the Visiting Nurse Associations of America.

But this is an exciting development for agencies, says Chapel Hill, NC-based consultant Judy Adams with the LarsonAllen Healthcare Group. It provides "the first real measure" of how successful you've been with OBQI activities, she explains.

There hasn't been much publicity about the three-bar reports, so folks may be confused when they first see them, Wardwell expects. But don't panic. Many parts of the report are similar to what you already know.

In both the new three-bar reports and the existing two-bar reports, the utilization outcome of "Any Emergent Care" now is part of the risk-adjusted outcome measures rather than being in the non-adjusted descriptive report section. But the outcomes measured and the report format, including definitions and computations,have not otherwise changed.

When you look at the new three-bar reports, in both the risk-adjusted and the descriptive sections, you'll see one bar for the current time period the agency requested, one national reference period bar for the same dates and one prior period bar for the same months in the previous year.

If you request a case mix report to go with your OBQI outcome report, the dates for the current, prior and reference columns will be the same for both reports, the supplement notes.

The new reports increase the opportunities for comparisons to be statistically significant - meaning the apparent difference between the numbers is likely to be real. As in the two-bar reports, if an outcome is statistically significant when compared with the national reference rate it will be marked with asterisks (*). In addition, if an outcome is statistically significant when compared with the prior year's outcome for the agency, it will be marked with pluses (+).

The three-bar report "provides a whole new dimension to the OBQI information,"Adams says. It addresses "the heart of OBQI" - evaluating the corrective actions you're taking and benchmarking your agency against itself. You can look at your agency "in new and creative ways," she adds.

People have been waiting for information that will tell them how they compare with their prior year, says Chicago-based regulatory consultant Re-becca Friedman Zuber. It gives agencies a sense of what they've been able to do, even if they haven't begun to do much formal performance improvement, and helps them evaluate their data quality, she adds.

Agencies do need to be aware that they're likely to see changes in their "prior year" report information, because of changes in risk adjustment methodology and because additional assessments received for that time period have been added, Adams warns. In the risk-adjusted section, the prior year's outcomes are altered to reflect any significant change between theagency's case mix in the prior year and its current case mix, so the comparison of the prior year and current year figures is more meaningful.

TIP: Looking first at the new three-column case mix report will help you determine whether there is any significant change in your agency's case mix between the current report period and the prior period. If there has been a change, this will show up in the risk-adjusted part of the OBQI report, but not in the descriptive part.

Since three-bar reports let agencies see if their corrective action plans really make a difference, this should provide an incentive for agencies to get started on the OBQI process, Adams says. And the sooner you start, the sooner you will obtain meaningful data for your operations. For agencies going forward with selecting target outcomes, the supplement contains a number of pages to help guide you through the process, as well as helpful frequently asked questions.

On the down side, the reports also will provide surveyors with more ammunition to question agencies on their quality of care efforts, Adams warns. Be prepared to explain to surveyors what you've been doing in the OBQI process and what reasons you think are behind your results - especially if your corrective action plans "were less than successful," she recommends.

But don't be surprised if it takes surveyors some time to catch up with how OBQI will change the survey process, Zuber says.