OASIS Alert

With the recent release of the OBQI reports, many home health agencies are scratching their heads about the difference between OBQI and OBQM if they realize there is a difference.

Outcome-based quality improvement (OBQI) is very different from outcome-based quality monitoring (OBQM), and agencies that don't recognize the initiatives as separate entities could wind up performing poorly on one or the other. That could lead to more frequent and thorough visits from surveyors (see Eli's OASIS Alert, Vol. 3, No. 3, p. 35).

A lot of agencies already have OBQM processes in place, says Kathy Green, director of education at Provider Solutions Corp. in Tampa, FL. And Green has seen many agencies with already established OBQM processes make the assumption that the adverse events reports are all they have to worry about, she tells Eli.

On the other hand, some agencies that have been learning about OBQI assume that OBQM is the same thing.

OBQM is based on adverse event reports, while OBQI has to do with the newly released risk-adjusted outcomes reports, clarifies consultant Cyndi Rohret with Briggs Corp. in West Des Moines, IA. Agencies easily can confuse the two because they must obtain both reports from the state OASIS server, and each report is derived from the data the agency collects through OASIS, she notes.

But that's about where the similarities between the two initiatives stop. The primary and essential difference between OBQI and OBQM is their ultimate goals. The goal of OBQM is for agencies to examine specific adverse events to determine possible areas of care that need improvement. That is, agencies are striving to reduce the incidence of adverse events, explains Green.

OBQI, on the other hand, aims to serve a much broader purpose. These reports examine far more outcomes than the 13 adverse events pinpointed in OBQM, and agencies must choose a couple of these outcomes to target for improvement or reinforcement, Green says (see the chart above for a tabular listing of the differences between OBQI and OBQM).

Even though the processes and approaches for each initiative are distinct and separate, agencies should use them in conjunction with one another. OBQI and OBQM reports should be taken together as a "starting point" from which agencies can begin to "focus their performance improvement efforts," advises Amanda Twiss, president of Outcome Concept Systems in Seattle.

Much of the confusion about OBQI versus OBQM likely stems from the Centers for Medicare & Medicaid Services itself, posits Green. When OBQI and OBQM first became a topic of conversation and CMS began releasing information about the initiatives, the agency "called everything OBQM," she laments. "OBQI was a subset of OBQM."

CMS has since defined the initiatives as two separate processes, but many agencies recall the early lack of distinction and remain confused. However, "people need to know that there are two different processes, and the uniqueness of those processes," Green urges.