Improve Your Home Health For Quality Living Life
Home Health Quality Initiatives
As a report from www.medicare.gov, more than 2.4 million elderly and disabled people with Medicare receive care from over 8,100 Medicare-certified home health agencies throughout the United States. Home health is covered under the Part A Medicare benefit. It consists of part-time, medically necessary skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) that is ordered by a physician. If patients are eligible for skilled services, they can also receive part-time assistance with personal care needs by a home health aide. Patients are required to be “homebound” as a condition of eligibility for these services.
In 2000, as part of a broad quality improvement initiative, the federal government began requiring that every Medicare-certified home health agency complete and submit health assessment information for their clients. The instrument/data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS). Since fall 2003, CMS has posted on www.medicare.gov a subset of OASIS-based quality performance information showing how well home health agencies assist their patients in regaining or maintaining their ability to function. Measures of how well people can get along in their homes performing activities of daily living (ADLs) form a core of the measures, but these are supplemented with questions about physical status and two use-of-service measures (hospitalization and emergent care).
In 2004-05, a private non-profit organization, the National Quality Forum (NQF), convened technical experts representing varying perspectives to review quality measures for home health care. Following a long review and consensus development process, the group endorsed measures for use in public reporting. The ten measures CMS includes in Home Health Compare (as of September 2005) reflect those recommendations.
The measures (all collected via the OASIS data set) are:
- Improvement in Ambulation/Locomotion
- Improvement in Bathing
- Improvement in Transferring
- Improvement in Management of Oral Medication
- Improvement in Pain Interring with Activity
- Acute Care Hospitalization
- Emergent Care
- Discharge to Community
- Improvement in Dyspnea (Shortness of Breath)
- Improvement in Urinary Incontinence
Another part of the HHS/CMS quality initiative includes Quality Improvement Organizations (QIOs). QIOs exist in each state and are private organizations that contract with CMS to help improve the quality of care provided to Medicare patients. In addition to assisting beneficiaries with complaints about the quality of care they receive, physicians and other health care experts work with home health agencies to encourage the adoption, use, and monitoring of best practices and quality measures.
While the current home health assessment and reporting tool, OASIS, will remain in use in the foreseeable future, several new priorities have emerged and are expected to be part of planning for the future:
- Pay for Performance – tying a portion of reimbursement to delivery of care that has been proven to be effective
- Standardizing assessment/quality measurement across (post-acute) health care settings
- Integration of measures of process and systems
- Electronic Health Record (EHR)
It is too early to know what forms these priorities may take. Pay for performance logically will link to actual activities and efforts of providers - using evidence-based practices and systems (in the form of structural measures that will be collected at the agency level) - to promote use of such practices. Planning/discussions are in a preliminary phase. Providers, consumers, and interested parties, such as the many organizations that represent and work with patients in post-acute, home, community, and long-term care settings will be part of these efforts as they evolve.
For more information see www.medicare.gov
Tags: Health Quality, Lifestyle, Living Plan