Posted on Tuesday, May 30, 2017 2:45 PM
Measuring the quality of home health care is important because it informs providers how the health system is performing and leads to improved care. Agencies should know their quality metrics to ensure positive patient outcomes and to identify what works and what doesn’t work to drive improvement. In 2007 Home Health Quality Reporting Program (HH QRP) was implemented requiring agencies to report quality data using the OASIS assessment or be subject to financial penalties. There are two categories of quality measures used in HH QRP:
1. Outcome measures
a. Improvement measures
b. Potentially avoidable events
c. Utilization of care (claim based measures)
2. Process measures
In 2015 CMS gathered a Technical Expert Panel (TEP) to evaluate the value and scientific basis of all the quality measures. Some of the measures are used in the Home Health Quality Initiative (HHQI), and other measures are used in the HH QRP. As a result of the comprehensive reevaluation of the quality measures the TEP group found grounds to remove 6 process measures from the HH QRP (see Figure 1) and a mix of 28 process and outcome measures (see Figure 2) from the HHQI. TEP group ultimately concluded that the following measures had either “topped out” and/or determined to be of limited clinical and quality improvement value.
In January 2017 the 6 HH QRP process measures were removed from Home Health Compare (HHC) website. Both the HH QRP and HHQI measure identified for exclusion will also be removed from all on- demand agency- level Certification and Survey Provider Enhanced Reports (CASPER) reports starting in 2018. Agencies will still be able to track patient-level data on these measures if interested in tracking/improving these measures from their Tally Reports.
Due to these findings and changes on what is publicly reported agencies should evaluate their own quality processes and initiatives. Is your quality assurance team spending time reviewing OASIS items that have been removed from these reports? Do you need to reevaluate what performance improvement projects your agency is working on based on this information?
With the removal of some measures, CMS did adopt four new measures to meet the requirements of the IMPACT Act. To find a full list of what has been removed and the new measures please visit CMS website https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIQualityMeasures.html
Figure 1. HH QRP Measures Removed
|
HH QRP Measure Title |
Measure Type |
|
1. Pain Assessment Conducted |
Process |
|
2. Pain Interventions Implemented during All Episodes of Care |
Process |
|
3. Pressure Ulcer Risk Assessment Conducted |
Process |
|
4. Pressure Ulcer Prevention in Plan of Care |
Process |
|
5. Pressure Ulcer Prevention Implemented during All Episodes of Care |
Process |
|
6. Heart Failure Symptoms Addressed during All Episodes of Care |
Process |
Figure 2. HHQI Measures Removed
|
HHQI Measure Title |
Measure Type |
|
1. Depression Interventions in Plan of Care |
Process |
|
2. Depression Interventions Implemented during All Episodes of Care |
Process |
|
3. Falls Prevention Steps in Plan of Care |
Process |
|
4. Falls Prevention Steps Implemented for All Episodes of Care |
Process |
|
5. Pain Interventions in Plan of Care |
Process |
|
6. Pressure Ulcer Treatment Based on Principles of Moist Wound Healing in Plan of Care |
Process |
|
7. Treatment of Pressure Ulcers Base on Principles of Moist Wound Healing Implemented during All Episodes of Care |
Process |
|
8. Physician Notification Guidelines Established |
Process |
|
9. Drug Education on High Risk Medications Provided to Patient/Caregiver at Start of Episode |
Process |
|
10. Potential Medication Issues Identified and Timely Physician Contact at Start of Episode |
Process |
|
11. Potential Medication Issues Identified and Timely Physician Contact during All Episodes of Care |
Process |
|
12. Emergent Care for Injury Caused by Fall |
Potentially Avoidable Event |
|
13. Emergent Care for Wound Infections, Deteriorating Wound Status |
Potentially Avoidable Event |
|
14. Improvement in Anxiety Level |
Outcome |
|
15. Improvement in Urinary Incontinence |
Outcome |
|
16. Improvement in Behavior Problem Frequency |
Outcome |
|
17. Improvement in Speech and Language |
Outcome |
|
18. Improvement in Urinary Tract Infection |
Outcome |
|
19. Improvement in Grooming |
Outcome |
|
20. Improvement in Toileting Hygiene |
Outcome |
|
21. Improvement in Eating |
Outcome |
|
22. Improvement in Light Meal Preparation |
Outcome |
|
23. Improvement in Phone Use |
Outcome |
|
24. Stabilization in Speech and Language |
Outcome |
|
25. Stabilization in Cognitive Functioning |
Outcome |
|
26. Stabilization in Anxiety Level |
Outcome |
|
27. Stabilization in Light Meal Preparation |
Outcome |
|
28. Stabilization in Phone Use |
Outcome |
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