home health quality 2019 update - wild apricot conference/pp/home h… · pathway to quality...

Home Health Quality 2019 Update

April 30, 2019

Marian Essey, RN BSN COS‐CSenior Director

OASIS Answers, Inc.

© 2019 OASIS Answers, Inc.

© 2019 OASIS Answers, Inc. 2

Quality Measure Changes 2019

Quality Measurement Pathway

NEW Quality

Measures

Star Rating

Changes

HHVBP Measure Changes

Quality Measure

(QM) Definitions

CASPER Report

Changes

OAI Strategic Guide to

2019 Quality Measures &

Reports

Risk Adjustment Changes

Resources to Keep

YOU in the know!

TODAY'S TOPICS




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!

OASIS Answers Annual COS‐C Conference September 25, 2018


PATHWAY TO QUALITY MEASUREMENT FOR HOME HEALTH AGENCIES

OASIS-D

Example

January 2019 Data Collection Begins

Review Review and Correct Reports

April 20191st Updated with New Measures 4/1/2019 (quality episodes that end 1/1/2019-3/31/2019)

CASPER CASPER Quality Measure Reports

January 20201st Updated with New Measures*

Home Health Compare

January 20211st Updated with New Measures

* Initial data reported on new measures in CASPER QM Reports will be < 1 year of data




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!


DEFINITION FOR OASIS-BASED MEASURES: QUALITY EPISODE

Period of time used in the calculation of quality measures

BEGINS with a SOC or ROC assessment, and ENDS with the next Transfer, Discharge or Death at Home

Does not include recerts

Not the same as payment episodes

Length of time between the start and end is not relevant

Improvement: Moving from a higher numeric score on the OASIS response scale at SOC or ROC to a lower numeric score at discharge

Quality EpisodeBegins with

SOC or ROC

Ends with

Transfer,Discharge, or Death

ExampleQuality Measure:Improvement in Dyspnea


Sun Mon Tues Wed Thurs Fri Sat

1

SOC2 3 4 5 6 7

8 9 10 11 12

TRN13 14

15 16 17 18 19 20 21

ROC22 23 24 25 26

TRN27 28

29 30 31 32 33 34 35

36 37 38

ROC39 40 41 42

43 44 45 46 47 48 49

50 51 52 53 54 55 56

57 58 59 60

DC

3 QUALITY episodes in one

PAYMENT episode

3 PAYMENT episodes in

one QUALITY episode

“QUALITY” EPISODE VS “PAYMENT” EPISODE

7


DEFINITION FOR OASIS-BASED MEASURES:GENERIC EXCLUSIONS

Generic ExclusionsDenominator excludes patients who • Do NOT have any of the 4 home care

payment sources: o Medicare (traditional fee‐for‐serviceo Medicare (HMO/managed care/Advantage

plan), o Medicaid (traditional fee‐for‐service), oro Medicaid (HMO/managed care), OR• Are less than 18 years, OR• Are receiving pre‐ and/or post‐partum

maternity services, OR• Are receiving personal care only

Non-MedicareNon-Medicaid

Payer< 18 years old

Receiving Pre-Post Partum

Maternity Services

Receiving Personal Care

ONLY




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!



2019: 3 NEW QUALITY MEASURES

OASIS-DBegan 1/1/2019

Review & Review & Correct ReportsBegins April 1, 2019

CASPER Quality Measure ReportsBegins January 2020

Home Health CompareBegins January 2021

Measure 1:

Changes in Skin Integrity Post-Acute Care: Pressure Ulcers/Injuries

Measure 2:

% Patients Experiencing One or More Falls with Major Injury

Measure 3:

% of Patients with Admission and Discharge Functional Assessment and Care Plan that Addresses Function


2019 NEW MEASURE:Changes in Skin Integrity Post-Acute Care: Pressure Ulcers/Injuries

Measure Description

Percentage of quality episodes in which the patient has one or more Stage 2-4 pressure ulcers, or an unstageable ulcer/injury, present at discharge that are new or worsened since the beginning of the quality episode.

LOWER RATES ARE BETTER!

Numerator

The number of completed quality episodes for patients whose assessment at discharge indicates one or more new or worsened Stage 2-4 or unstageable pressure ulcers/injuries compared to the start or resumption of care assessment.

Denominator

Number of home health quality episodes ending with a discharge during the reporting period, other than those covered by generic or measure-specific exclusions.

Measure Exclusions

Episodes that end in a death at home or transfer to an inpatient facility.Episodes without an assessment completed at the start or resumption of care and an assessment completed at discharge.Episodes are excluded if the discharge assessment does not have a usable response for M1311a, M1311b, M1311c, M1311d, M1311e or M1311f. A valid skip (“^”), is considered a usable response.

OASIS Item Used to Calculate this Measure:

M1311

Risk Adjusted


PROPOSED RISK ADJUSTMENT:CHANGES IN SKIN INTEGRITY POST-ACUTE CARE: PRESSURE ULCER/INJURY

Risk Factor When Applied

M1620 Bowel Incontinence If M1620 at SOC/ROC = [2, 3, 4, 5]

M1028 Active Diagnoses If M1028 at SOC/ROC = [1] or [2]

M1060 Height and Weight If BMI at SOC/ROC ≥ [12.0] AND ≤ [19.0]

GG0170C Mobility: Lying to Sitting on Side of Bed

If GG0170C at SOC/ROC = [01, 02, 03, 04, 07, 09, 88]

M1311 at Discharge:If X1-X2=0


PATIENT-LEVEL EXAMPLEChanges in Skin Integrity Post-Acute Care: Pressure Ulcers/Injuries

What doI need

to do to succeed?

Success!

1

1


2019 NEW MEASURE:% Patients Experiencing One or More Falls with Major Injury

Measure Description

Percentage of quality episodes in which the patient experiences one or more falls with major injury (defined as bone fractures, joint dislocations, closed-head injuries with altered consciousness, or subdural hematoma) during the home health episode.


Numerator

Number of quality episodes in which the patient experienced one or more falls that resulted in major injury during the episode of care.

p

Denominator

Number of home health quality episodes ending with a discharge, transfer, or death during the reporting period, other than those covered by generic or measure-specific exclusions.

Measure Exclusions

Episodes during which the occurrence of falls was not assessed.Episodes where the assessment indicates that a fall occurred AND the number of falls with major injury was not assessed.


J1800 –Any falls since SOC/ROCJ1900 – Number of falls since SOC/ROC

Not Risk Adjusted


PATIENT-LEVEL EXAMPLE% Patients Experiencing One or More Falls with Major Injury

J1800. Has the patient had any falls since the SOC/ROC whichever is more recent?

0. No1. Yes

0

What doI need

to do to succeed?

J1800 = 0 - No

OR

If J1800=1-Yes, thenJ1900C = 0

Success!


2019 NEW MEASURE:% of Patients with Admission and Discharge Functional Assessment and Care Plan that Addresses Function

Measure Description

Percentage of home health quality episodes in which patients’ mobility and self-care functional status was documented at SOC/ROC and discharge and at least one discharge goal was recorded.

HIGHER RATES ARE BETTER!

Numerator

Number of home health quality episodes with functional assessment data for each self-care and mobility activity and at least one self-care or mobility goal.

Denominator

Number home health quality episodes ending with discharge, death, or transfer to inpatient facility during the reporting period, other than those covered by generic exclusions.

Measure Exclusions

None

OASIS Item Used to Calculate this Measure:(GG0130A) Eating (GG0130B) Oral Hygiene (GG0130C) Toileting Hygiene (GG0170B) Sit to Lying (GG0170C) Lying to sitting on the side of the bed (GG0170D) Sit to Stand (GG0170E) Chair/bed-to-chair transfer (GG0170F) Toilet transfer (GG0170J) Walk 50 feet with 2 turns (GG0170K) Walk 150 feet (GG0170R) Wheel 50 feet with 2 turns (GG0170S) Wheel 150 feet

Process Measure Not Risk Adjusted

Items Included in the Measure SOC/ROC Performance

Score

Discharge Performance

Score

Discharge Goal Documented

(at SOC/ROC)

GG0130A Eating

Valid numeric score or activity not attempted

codeis coded for adischarge goal

for at least one of the listedself-care or

mobility activities

GG0130B Oral Hygiene

GG0130C Toileting Hygiene

GG0170B Sit to Lying

GG0170C Lying to sitting on side of bed

GG0170D Sit to Stand

GG0170E Chair/bed-to-chair transfer

GG0170F Toilet transfer

For patients who are walking, complete the following items:

GG0170J Walk 50 feet with 2 turns

GG0170K Walk 150 feet

For patients who use a wheelchair/scooter, complete the following items:

GG0170R Wheel 50 feet with 2 turns

GG0170S Wheel 150 feet © 2019 OASIS Answers, Inc.

17

PATIENT-LEVEL EXAMPLE% of Patients with Admission and Discharge Functional Assessment and Care Plan that Addresses Function

What doI need

to do to succeed?

SOC/ROC Performance (all activities)

+Discharge

Performance (all activities)

+Discharge Goal Documented at

SOC/ROC (at least one of

these 12 activities)


% of Patients with Admission and Discharge Functional Assessment and Care Plan that Addresses Function

How is this measure

calculated for patients who are

transferred or who die?

I don’t score the discharge

performance then…

For episodes ending in transfer or death at home, to be counted in the numerator: • A valid numeric score indicating the

patient’s functional status, or a valid code indicating the activity was not attempted or could not be assessed for each of the functional assessment items on the SOC/ROC assessment;

AND • A valid numeric score or activity not

attempted code, which is a discharge goal indicating the patient’s expected level of independence, for at least one self-care or mobility item on the SOC/ROC assessment.

Nurse Nate




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!


HHVBP QUALITY MEASURES 2019• Removal of 2 OASIS-based measures

o Influenza Immunization Received for Current Flu Seasono Pneumococcal Polysaccharide Vaccine Ever Received

• Replacement of 3 OASIS-Based Measures With 2 Composite Measureso Remove

• Improvement in Bathing• Improvement in Bed Transferring• Improvement in Ambulation/Locomotion

o Replace with• Total Normalized Composite Change in Self-Care • Total Normalized Composite Change in Mobility

20

HHVBP


(TNC) CHANGE IN SELF-CARE

Description: The magnitude of change, either positive or negative, based on a normalized amount of possible change on each of six OASIS-based quality outcomes:

• Improvement in Grooming (M1800)

• Improvement in Upper Body Dressing (M1810)

• Improvement in Lower Body Dressing (M1820)

• Improvement in Bathing (M1830)

• Improvement in Toileting Hygiene (M1845)

• Improvement in Eating (M1870)

21

HHVBP


(TNC) CHANGE IN MOBILITY

Description: The magnitude of change, either positive or negative, based on a normalized amount of possible change on each of three OASIS-based quality outcomes:

• Improvement in Toilet Transferring (M1840)

• Improvement in Bed Transferring (M1850)

• Improvement in Ambulation/Locomotion (M1860)

22

HHVBP


Magnitude of Change

23

HHVBP

The magnitude of possible change for OASIS items in these measures varies based on the number of response options.

Example:

M1800 (Grooming) 4 response options 0 = most independent3 = least independent

Therefore 3 is the maximum possible change

M1830 (Bathing) 7 response options 0 = most independent 6 = least independentTherefore 6 is the

maximum possible change


TNC Measure Calculation Steps

24

HHVBP

Step Instructions Example

Step 1:Calculate absolute change score for each OASIS item in the measure

What is the change between SOC/ROC and discharge (positive or negative)?

M1800 Grooming at SOC=3M1800 Grooming at DC = 0Change = +3

Step 2:Normalize scores based onmaximum change possible for each OASIS item (The normalized scores result in a maximum possible change for any single item equal to ‘‘1’’; this score is provided when a patient achieves the maximum possible change for the OASIS item)

Take the “change” value from Step 1 and divide it by the “maximum possible change” for that item

Change in Grooming = +3

3 divided by 3 (maximum possible change) = 1

(The best possible score is 1)

Step 3: Total score is calculated bysumming the normalized scores for the items in the measure

Add the normalized scores for all the items in the measure

Grooming (M1800) =UB Dressing (M1810) = LB Dressing (M1820) = Bathing (M1830) =Toileting Hygiene (M1845) = Eating (M1870) = TOTAL =

1.000.330.660.140.000.002.13

Risk Adjustment: A prediction model is computed at the episode level

HHA Risk Adjusted =HHA Observed + National Predicted -HHA Predicted

Note: Because the Total Normalized Composite Change in Self‐Care and Mobility measures are composite measures rather than simply outcome measures, the terms "Numerator" and " Denominator" do not apply.


NEW - HHVBP MEASURES ARE WEIGHTED

25

CMS Home Health CY2019 PPS Final Rule

HHVBP


MEASURE: ACUTE CARE HOSPITALIZATION(DURING THE FIRST 60 DAYS OF HOME HEALTH)

Uses:Quality of Patient Care Star Rating &HHVBP

Consumer Language How often home health patients had to be admitted to the hospital.

Type Outcome Measure – Utilization

Measure Description Percentage of home health stays in which patients were admitted to an acute care hospital during the 60 days following the start of the home health stay.

Numerator Number of home health stays for patients who have a Medicare claim for an admission to an acute care hospital in the 60 days following the start of the home health stay.

Numerator Exclusions Planned hospitalizations (Based on AHRQ Procedure and Condition Clinical Classifications Software as well as other sets of ICD procedure codes

Denominator Number of home health stays that begin during the 12-month observation period. A home health stay is a sequence of home health payment episodes separated from other home health payment episodes by at least 60 days.

DenominatorExclusions

Home health stays that begin with a Low Utilization Payment Adjustment (LUPA) claim. Home health stays in which the patient receives service from multiple agencies during the first 60 days. Home health stays for patients who are not continuously enrolled in fee-for-service Medicare for the 6 months prior to and the 60 days following the start of the home health stay or until death. Planned hospitalizations are excluded from the numerator.

HHVBP




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!


2 TYPES OF HH STAR RATINGS

QoPC Star Rating• Based on OASIS

Assessments and Medicare claims data

Patient Survey Star Rating• Based on the

patient experience of care measures(HHCAHPS)

My Home Health Agency

The Other Guy’s Home Health Agency

Next Door Neighbor Home Health Agency


FINDING QUALITY OF PATIENT CARE STAR RATINGS ON HOME HEALTH COMPARE

1. www.Medicare.gov2. “Home Health

Compare”3. Choose agencies to

compare (up to 3)4. “Quality of patient

care” tab5. “Quality of patient

care star ratings”

My Home Health Agency

The Other Guy’s Home Health Agency

StateAverage

NationalAverage


QOPC STAR RATINGSTATE & NATIONAL DISTRIBUTIONS

“CLICK” to reveal graphs of distribution of state and national star ratings


QOPC STAR RATINGSTATE RESULTS

Agency #1Agency #2Agency #3


QOPC STAR RATINGNATIONAL RESULTS

Agency #1Agency #2Agency #3


QUALITY MEASURE INSIGHTS 2019QOPC STAR RATING

January 2019Last reporting of Drug Education process measure

April 2019First reporting of Improvement in Management of Oral Medications outcome measure

ReminderAcute Care Hospitalization is a claims-based measure

33


QOPC STAR RATINGPROVIDER PREVIEW REPORT

• Agency‐specific data on each of the 8 measures used to calculate the Quality of Patient Care Star Rating

• Access via CASPER Reporting link ‐ at the top of your QIES HHA State Welcome page

• Posted approximately 3 months prior to the Home Health Compare update

• Only available for 120 days in the CASPER folder

• Agencies able to review for inaccurate or incomplete data used to calculate measures


QOPC STAR RATING-PROVIDER PREVIEW REPORT SCORECARD


QUALITY OF PATIENT CARE STAR RATINGRESOURCES https://www.cms.gov/Medicare/Quality-

Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings.html


2019 Quality Measures:QoPC Star RatingQuality Measures QoPC Star

OASIS-Based 2018 2019Improvement in Bathing

Improvement in Bed Transferring

Improvement in Ambulation/Locomotion

Improvement in Management of Oral Medications APRIL2019

Improvement in Dyspnea

Improvement in Pain Interfering with Activity/Movement

Timely Initiation of Care

Drug Education on All Medications Provided to Patient/CG END JAN 2019

Claims-Based 2018 2019

Acute Care Hospitalization During the First 60 Days of HH

Emergency Department Use without Hospitalization During the First 60 days of Home Health

37© 2019 OASIS Answers, Inc.


MEASURE: IMPROVEMENT IN MANAGEMENT OF ORAL MEDICATIONS

Uses:Quality of Patient Care Star Rating &HHVBP

Consumer Language How often patients got better at taking their drugs correctly by mouth.

Type End Result Outcome

Measure Description Percentage of home health episodes of care during which the patient improved in ability to take their medicines correctly (by mouth).

Numerator Number of home health episodes of care where the value recorded on the discharge assessment indicates less impairment in taking oral medications correctly at discharge than at start (or resumption) of care.

Denominator Number of home health episodes of care ending with a discharge during the reporting period, other than those covered by generic or measure-specific exclusions.

Exclusions Home health episodes of care for which the patient, at start/resumption of care, was able to take oral medications correctly without assistance or supervision, episodes that end with inpatient facility transfer or death, or patient is nonresponsive, or patient has no oral medications prescribed.

OASIS Items Used (M2020) Management of Oral Medications (M1700) Cognitive Functioning (M1710) When Confused (M1720) When Anxious

HHVBP


M2020 ASSESSMENTASSESS: OBSERVATION, INTERVIEW & COLLABORATION

Mental/emotional/cognitive status –Examples:o Can remember what dose to take and

when to take it?o Can set up reminders, fill medi‐planners,

create a drug chart?Physical status – Examples:o Can open containers? Possess required

vision?o Requires someone’s assistance to

ambulate to location where meds routinely stored?

Activities permitted – Example:o Allowed or able to orally ingest

prescribed po meds?Environment – Example:o Can safely access medications & beverage

(if needed)?Knowledge of drug dose and administration scheduleo Knows what dose to take and when to

take it every time?39

(M2020) Management of Oral Medications: Patient's current ability to prepare and take all oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals. Excludes injectable and IV medications. (NOTE: This refers to ability, not compliance or willingness.)0 ‐ Able to independently take the correct oral medication(s) and

proper dosage(s) at the correct times.1‐ Able to take medication(s) at the correct times if:

(a) individual dosages are prepared in advance by another person; OR

(b) another person develops a drug diary or chart.2 ‐ Able to take medication(s) at the correct times if given reminders by another person at the appropriate times3 ‐ Unable to take medication unless administered by another

person.NA‐No oral medications prescribed.

M2020 CODING TIPS

40

Response 1 Response 2 Response 31‐ Able to take medication(s) at the correct times if:(a) individual dosages are prepared in advance by another person; (b) another person develops a drug diary or chart

2 ‐ Able to take medication(s) at the correct times if given reminders by another person at the appropriate times

3 ‐ Unable to take medication unless administered by another person

REQUIRES SOMEONE ELSE’S HELP

REQUIRES ANOTHER PERSON TO GIVE

REMINDERS

UNABLE TO TAKE MEDICATION UNLESS

ADMINISTERED BY ANOTHER PERSON

Needs doses set‐up in advance by another person and/or

Do not select “2” If patient can set up own daily reminders

At time of assessment, a barrier prevented patient from taking medications at correct time and dose at all times

Needs another person to set up a drug diary or chartSet‐up could include:Placing the meds in a medi‐planner or other container or device orModifying the original med container to enable patient to access meds correctly, e.g., removing childproof lids, marking the label for visually impaired or illiterate, or pouring into individual cups

If patient needs reminders for PRN meds, report what is true on day of assessment

If no need for PRN on day of assessment, don’t include that medication in your assessment.

Examples:

Did not take new meds because of worry or uncertainty or meds not in home

Not able to take meds at correct time/dose even though reminded

Unable to safely swallow prescribed oral meds

Needs assistance to ambulate. Meds and water not routinely stored within reach

If the patient’s ability to manage oral medications varies from medication to medication, consider themedication for which the most assistance is needed when selecting a response.



Functional Outcome MeasuresQuality Measures QoPC Star HHVBP

OASIS-Based 2018 2019 2018 2019

Total Normalized Composite (TNC) Change in Self-Care NEWTotal Normalized Composite (TNC) Change in Mobility NEWImprovement in Bathing

Improvement in Bed Transferring

Improvement in Ambulation/Locomotion

Improvement in Management of Oral Medications APRIL2019

Improvement in Dyspnea

Improvement in Pain Interfering with Activity/Movement

Discharged to Community

Timely Initiation of Care

Claims-Based 2018 2019 2018 2019

Acute Care Hospitalization During the First 60 Days of HH

Emergency Department Use without Hospitalization During First 60 days of Home Health

41


MEASURE: IMPROVEMENT IN BATHING

Uses:Quality of Patient Care Star Rating &HHVBPConsumer Language

How often patients got better at bathing. NA

Type Outcome Measure – End Result Composite

Measure Description

Percentage of home health episodes during which the patient got better at bathing self.

One of 6 items used to calculate TNC Change in Self-Care Measure

Numerator Number of home health episodes of care where the value recorded on the Discharge assessment indicates less impairment in bathing at Discharge than at Start (Resumption) of Care.

Terms "Numerator" and " Denominator" do not apply.The magnitude of change(either positive or negative) from SOC/ROC to dischargebased on the normalized amount of possible change on each of three OASIS-based qualityoutcomes.

Denominator Number of home health episodes of care ending with a Discharge during the reporting period, other than those covered by generic or measure-specific exclusions.

Exclusions Home health episodes of care for which the patient, at Start/Resumption of Care, was able to bath self independently, episodes that end with Transfer to inpatient facility or Death or patient is nonresponsive.

Home health episodes that end with Transfer to Inpatient Facility or Death

OASIS Items Used

(M1830) Bathing(M1700) Cognitive Functioning(M1710) When Confused(M1720) When Anxious

(M1830) Bathing

HHVBP

© 2019 OASIS Answers, Inc.43

MEASURE: IMPROVEMENT IN BED TRANSFERRING


How often patients got better at getting in and out of bed. NA


Measure Description

Percentage of home health episodes during which the patient improved in ability to get in and out of bed.

One of 3 items used to calculate TNC Change in Mobility Measure

Numerator Number of home health episodes of care where the value recorded on the Discharge assessment indicates less impairment in bed transferring at Discharge than at Start (Resumption) of Care

Terms "Numerator" and " Denominator" do not apply.The magnitude of change(either positive or negative) from SOC/ROC to dischargebased on the normalized amount of possible change on each of three OASIS-based quality outcomes.


Exclusions Home health episodes of care for which the patient, at Start/Resumption of Care, was able to transfer independently, episodes that end with Transfer to inpatient facility or Death or patient is nonresponsive.

Home health episodes that end with Transfer to inpatient facility or Death

OASIS Items Used

(M1850) Transferring(M1700) Cognitive Functioning(M1710) When Confused(M1720) When Anxious

(M1850) Transferring

HHVBP


MEASURE: IMPROVEMENT IN AMBULATION/LOCOMOTION


How often patients got better at walking or moving around.

NA


Measure Description

Percentage of home health episodes during which the patient improved in ability to ambulate.

One of 3 items used to calculate TNC Change in Mobility Measure

Numerator Number of home health episodes of care where the value recorded on the Discharge assessment indicates less impairment in ambulation/locomotion at Discharge than at SOC/ROC

Terms "Numerator" and " Denominator" do not apply.

The magnitude of change(either positive or negative) from SOC/ROC to discharge based on the normalized amount of possible change on each of three OASIS-based qualityoutcomes.


Exclusions Home health episodes of care for which the patient, at Start/Resumption of Care, was able to ambulate independently, episodes that end with Transfer to inpatient facility or Death or patient is nonresponsive.

Home health episodes that end with Transfer to inpatient facility or Death

OASIS Items Used

(M1860) Ambulation/Locomotion(M1700) Cognitive Functioning(M1710) When Confused(M1720) When Anxious

(M1860) Ambulation/Locomotion

HHVBP


SELF-CARE “M” FUNCTION ITEM CODING TIPS

45

M1800 Grooming M1810 Upper Body Dressing and 1820 Lower Body Dressing

IncludedWashing face and hands, Hair care, Shaving/make up, Teeth/denture care, Fingernail careGetting to/accessing grooming aids/mirror/sink

ExcludedBathing, shampooing hair, and toileting hygiene

Coding TipsIf ability varies between included tasks, report what is true the majority of the more frequently performed tasks

IncludedPut on and remove clothing items routinely wornAccess/get to/obtain clothing where routinely storedDevices ARE part of body apparel (e.g., prosthesis, orthotic, splint, corset, brace, elastic wraps for support/compress

ExcludedWraps utilized solely to secure a wound dressing

Coding TipsInclude dressing items and devices if wearing (or ordered to wear) device/support on day of assessmentDon’t make assumptions about what is routinely wornEach piece of clothing/ supportive device/prosthetic considered a dressing taskIf ability varies between dressing tasks code response that best describes ability in majority of the dressing tasks

M1830 Bathing M1845 Toileting Hygiene

IncludedSafely getting to the location where bathing occursTransferring in/out of the tub/showerWashing the entire body

ExcludedGathering suppliesPreparing the bath waterShampooing hairWashing face and handsDrying off after the bath

Coding TipsConsider Medical Restrictions If can’t bathe in tub/shower (e.g., no tub/shower, nonfunctioning, unsafe, medically restricted from getting in tub/shower, environmental barrier) Code 4, 5, or 6

IncludedPulling clothes down/upManaging incontinence pads before/after using toilet Adequately cleaning (wiping) perineal areaCaring for urinary catheterIf managing ostomy, includes cleaning area around all urinary & bowel stomas

ExcludedGetting to/from toilet/BSCTransfer on/offManaging ostomy equipment

Coding TipsDetermine ability to access/obtain needed supplies/implements and manage hygiene and clothingMajority of tasks rule DOES NOT apply for this itemIf patient can participate in hygiene and/or clothing management but needs some assistance with EITHER OR BOTH activities Code 2

M1870 Eating

IncludedAssistance needed to feed self once the food is placed

ExcludedPreparation of food items and Transport to the table

Coding TipsIdentifies ability to feed self (orally)



MOBILITY “M” FUNCTION ITEM CODING TIPS

46

M1840 Toilet Transferring

IncludedAbility to get to and from toilet with or without a deviceAbility to use the bedside commode with or without helpTransfer on/off toilet, commode and bedpan

ExcludedBathing, Personal hygieneClothing management when toiletingEmptying bedpan

Coding TipsIf patient is unable to get to/from toilet or BSC, but able to place and remove bedpan and urinal independently Code 3If patient can place and remove urinal, but needs assistance with bedpan Code 4If patient is totally dependent in toileting Code 4If there is no toilet, BSC or bedpan/urinal present in the home Code 4

M1850 Bed Transferring

IncludedMoving from supine position on current sleeping surface (bed, recliner, couch, etc.)To a sitting position on the side, then To some type of standing, stand‐pivot, sitting pivot or sliding board transfer to sitting surface (chair, bench, toilet, BSC, etc.) and then Back to supine position on sleeping surface

ExcludedNA

Coding TipsNeed for assistance to ambulate to chair in another room may impact scoreBedfast: On day of assessment, patient is either medically restricted to bed OR unable to tolerate being out of bedSleeping and sitting surfaces may varyMinimal means individual assisting is contributing less than 25% of total effort required to perform task

M1860 Ambulation/Locomotion

IncludedAbility to SAFELYWalk, once in standing position, orUse wheelchair, once in seated positionOn a variety of surfacesTypical surfaces routinely encountered in patient’s environment May vary based on individual residence

ExcludedTransfers

Coding TipsUsual Status greater than 50% of the Time convention does NOT apply when determining if patient is chairfast or bedfastIf need for devices (One‐handed/Two‐handed) varies between different surfaces and rooms, report device that makes patient safe on all surfaces Code 2If patient is not safe walking, even with combination of device and constant human assistance Code 4 or 5If patient can only take one or two steps to complete a transfer Code 4 or 5If patient is medically restricted to bed or unable to tolerate being out of bed Code 6





NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!


RISK ADJUSTMENT

What is Risk Adjustment?

1. A statistical process used to identify and adjust for

variation in patient characteristics that can affect

patient outcomes.2. Examples of these patient-level

risk factors (from SOC/ROC OASIS responses) include age,

gender, medical history, comorbid illnesses, behavioral factors and physiologic factors.

3. Risk Adjustment attempts to level the playing field and can

increase, decrease or not change your actual raw

measure score.

Example of Risk Adjustment

Your agency has an actual raw score for Improvement in Bathing of 70%.

Your agency’s SOC/ROC responses on certain OASIS items demonstrate higher than average characteristics that put your patients at risk for not

improving in bathing.

Your risk adjusted rate on Home Health Compare for Improvement in

Bathing is reported as 75% (adjusted upward) to reflect the higher

acuity/risk of your agency’s patients.


RISK ADJUSTMENT

Potentially Avoidable Events are no longer risk adjusted

Stabilization Outcome Measures are no longer risk adjusted

New Risk Models for the OASIS‐based measures have been developed and posted on the CMS Home Health Quality Reporting Program website

Do you know these Fun Facts for 2019…




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!


CASPER REPORTS

CASPER ‐ Certification And Survey Provider Enhanced Reports

Current Begin Date defaults to the month and year of the most recent data available that begins a full 12‐month reporting period

Prior Begin Date defaults to the month and year 12 months earlier than the Current Begin Date

The earliest Begin Date available is 01/2010, which corresponds to the implementation date of OASIS‐C

Branch information is available only for patients with episodes of care where the SOC/ROC and Discharge/Transfer assessments indicate the same Branch ID (M0016)

Did you know…


The Agency Patient-Related Characteristics (Case Mix) Report provides the mean value of each OASIS patient-related characteristics (patient attributes or circumstances) measure for episodes of care that ended during two specified periods (current and prior) for the agency, along with national reference mean values for the current period.

end of care

Characteristics are calculated from SOC/ROC data only unless data collection occurs only at end of care

CASPER QUALITY MEASURE REPORTS:AGENCY PATIENT-RELATED CHARACTERISTIC (CASE MIX) REPORT


Removed characteristics that cannot be calculated due to removal of items from OASIS‐D₋ Examples: ₋ “Reason for Hospitalization” characteristics have been removed

because M2430 (Reason for Hospitalization) has been removed with OASIS‐D

₋ “Acute Conditions” characteristics have been removed because M1011 (Inpatient Diagnoses) and M1017 (Diagnoses Requiring Medical or Treatment Regimen Change within Past 14 Days) have been removed with OASIS‐D

Characteristics added due to new items on OASIS‐D₋ Examples: ₋ “Functional Abilities” have been added that correspond with

OASIS‐D Section GG Functional Abilities items₋ “Health Conditions” have been added that correspond with

OASIS‐D Section J‐ Falls itemsHome Care Diagnoses have been updated to align with ICD‐10 coding categories(beginning January 2019)



For early January 2019 ‐ Actual Current Period Reported (most recent data available) ends September 2018

For early January 2019 ‐ Actual Current Period Reported (most recent data available) ends September 2018



New characteristics added for M1311 to allow agencies to monitor their population of patients with pressure ulcers/injuries at all stages

New characteristics added for M1311 to allow agencies to monitor their population of patients with pressure ulcers/injuries at all stages

“‐‐‐” indicates that there is no data available for these fields

“‐‐‐” indicates that there is no data available for these fields

New fields correspond with new items and updates on OASIS‐D



Pages 2‐3 contain new characteristics for Functional Abilities calculated from GG0100 Prior FunctioningGG0110 Prior Device UseGG0130 Self‐CareGG0170 Mobility



Page 4 ‐ New characteristics added for J1800 and J1900 to allow agencies to monitor their population of patients with falls

Note: Uses definition of falls for J1800 and J1900 only and may not match other definitions of falls.

Page 4 ‐ New characteristics added for J1800 and J1900 to allow agencies to monitor their population of patients with falls

Note: Uses definition of falls for J1800 and J1900 only and may not match other definitions of falls.

“Falls” are calculated at end of care



The Outcome Report provides agency observed, national observed and, where available, risk-adjusted prior and Home Health Compare risk-adjusted measure performance comparisons.

End Results Outcomes are computed only for episodes of care ending with a discharge from agency (RFA = 09).

Utilization Outcomes are computed for episodes of care ending with a transfer to an inpatient facility (RFA = 06 or 07) or a discharge from agency (RFA = 09).

Claims Based Outcomes are calculated based upon the Episode Begin Date.

CASPER QUALITY MEASURE REPORTS:OUTCOME REPORT



For January 2019 ‐ Actual Current Period Reported for OASIS‐Based Measures (most recent data available) ends September 2018

For January 2019 ‐ Actual Current Period Reported for OASIS‐Based Measures (most recent data available) ends September 2018

Outcome Report measures have been reorganized and categorized by Risk Adjusted and Non‐Risk Adjusted Measures


Pages 1‐3Risk‐Adjusted OASIS‐BasedEnd Result Outcomes


Page 4Non‐ Risk‐AdjustedOASIS‐Based End Result Outcomes

62

Utilization Outcome

Page 5Risk‐Adjusted OASIS‐BasedUtilization Outcome


63

Claims‐Based Measure Reporting Period Do Not Match OASIS‐Based Reporting Periods

Page 6Risk‐Adjusted Claims‐Based Outcomes

Pages 7‐8Medicare Spending Per Beneficiary Measure



Outcome Report(beginning January 2019)

NEW MEASURES ADDEDNone

MEASURES REMOVED

1. Acute Care Hospitalization (OASIS-based)

2. Emergency Dept Use with Hospitalization (OASIS-based)


The Process Measures Report identifies the agency’s performance for each process measure for episodes of care that ended during two specified periods (current and prior), along with national reference rates for the current period.

CASPER QUALITY MEASURE REPORTS:PROCESS MEASURES REPORT

Beginning January 2019

NEW MEASURES ADDEDNone

MEASURES REMOVEDDiabetic Footcare and Patient Education in Plan of Care


CASPER REPORTS:REVIEW & CORRECT REPORT

No changesto this report until April 2019

The HHA Review and Correct Report allows home health agencies to review their quality measure (QM) data to identify if there are any corrections or changes necessary prior to the quarter's data submission deadline, which is 4.5 months after the end of the quarter.

January 2019: Most recent quarter available is October‐December 2018January 2019: Most recent quarter available is October‐December 2018


CASPER REPORTS:REVIEW & CORRECT REPORT

The HHA Review and Correct Report allows home health agencies to review their quality measure (QM) data to identify if there are any corrections or changes necessary prior to the quarter's data submission deadline, which is 4.5 months after the end of the quarter.

Includes all OASIS-based publicly reported measures.


REVIEW & CORRECT REPORT EVOLUTIONApril 2017: Agency-Level Data ONLY

April 2019Agency-Level & Patient-Level Data

New feature in April 2019!!!Patient-Level data


Review and Correct Report(beginning April 2019)

NEW MEASURES ADDED

1.NEW - Changes in Skin Integrity Post-Acute Care: Pressure Ulcers/Injuries

2.NEW - % Patients Experiencing One or More Falls with Major Injury

3.NEW - % of Patients with Admission and Discharge Functional Assessment and Care Plan that Addresses Function

MEASURES REMOVED

None


HOME HEALTH PUBLIC REPORTING OVERVIEW

CAS

PER Review

& Correct Reports C

ASPE

R

Quality Measure (QM) Reports* C

ASPE

R HomeHealth CompareProvider Preview Report

Home Health Compare

Confidential Reporting

Public Reporting

• Tally Reports

CASPER QM Reports:• Outcome Report• Process Measures Report• Agency Patient-Related Characteristics (Case Mix)

Report• Tally Reports


COMPARING 3 TYPES OF CONFIDENTIAL CASPER QUALITY REPORTS

Review & Correct Report• On-demand • Displays quarterly observed rates• New quarter is available the day after the end of the calendar quarter

then updated weekly

Quality Measure (QM) Reports• On-demand• Defaults to annual observed and risk adjusted rates (but can select

monthly or quarterly) • Most recent data has a 3 month lag for OASIS-based measures (e.g.,

reports available April will have end date of January)

Home Health Compare Preview Report• Distributed and placed in CASPER folders• Available quarterly, approximately three months prior to display on

Home Health Compare• Measure results are risk adjusted (if applicable); results are final and

cannot be updated



MEASURE EXAMPLE:% PATIENTS EXPERIENCING ONE OR MORE FALLS WITH MAJOR INJURY

OASIS-D

Example of NEW 2019 measure with data collection that began January 2019

Review Review and Correct Reports

April 20191st Updated with New Measures 4/1/2019 (quality episodes that end 1/1/2019-3/31/2019)

CASPER Quality Measure Reports

January 20201st Updated with this measure

Home Health Compare

September 2020 - Home Health Compare Preview Reports

January 2021Home Health Compare

Why are the R&C Reports important?



REVIEW & CORRECT REPORT:DATA CORRECTION PERIODS & DEADLINE

Quarter Calendar Dates

Quarter Added to

R&C Report

Data Correction Deadline

Quarter 1 1/1 - 3/31 April 1 August 15

Quarter 2 4/1 – 6/30 July 1 November 15

Quarter 3 7/1 – 9/30 October 1 February 15

Quarter 4 10/1 – 12/31 January 1 May 15

OASIS data corrections must occur on or before the data correction deadline to be reflected in your Home Health Compare scores.



DATA CORRECTION: THE CLOCK IS TICKING!Quarter Calendar Dates Data Correction

Deadline

Quarter 12019 1/1 - 3/3 2019

August 15, 2019

4 1/2 months from close of calendar

quarterQuality episodes that end in

March 2019 1st appear on the

QM Reports June 2019* ~ 60 days

Quality episodes that end in March 2019

1st appear on Home Health

Compare (HHC) Preview Reports

September 2019*

0 days(no opportunity to

correct data reported on HHC)

Quality episodes that end in March 2019

1st reported on HH Compare

January 2020*0 days

(opportunity to correct HHC data ended

8/15/19)

Example

* Does not include new 2019 measures



POSTED BY CMS:PREVIEW REPORT & DATA SUBMISSION/CORRECTION DATES

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Data-Submission-Deadlines.html


REVIEW & CORRECT REPORT OPTIONS

Agency-Level Data

Patient-Level Data


REVIEW & CORRECT REPORT OVERVIEW

1 23

4

1. Agency demographic information for the CCN

2. Report dates–defaults to the most recently available calendar quarter

3. Quality measures –defaults to all available measures (can also select specific measures)

4. Reporting Quarter –lists all quarters on the report

5. Data Correction Status – open, closed, or both

NOTE: Quality measure calculations are performed weekly and on the first day of each quarter.

5

Agency-Level Data



6

6. Table Legend

Dash (-) = Data is not available or not applicable

When patient level data is selected:X = Triggered (counted in the measure numerator)NT = Not Triggered (not counted in the measure numerator)E = Excluded from the quality measure calculation

My HHA

Agency-Level Data



7 8 10

7. Reporting Quarter –Calendar quarter and calendar year for which the data were collected (quality episode ended)

8. Start Date–Beginning date of the reporting quarter

9. End Date –Ending/last date of the reporting quarte

10. Data Correction Deadline – After this date, data for the reporting quarter are frozen for public reporting purposes.

9

Agency-Level Data



11. Data Correction Period as of Report Run Date -

Open = Deadline is either today or in the future; data may still be corrected Closed = Deadline is in the past; data can no longer be corrected

12. Number of HH Episodes Included in the Numerator

13. Number of HH Episodes Included in the Denominator

14. Your Agency’s Observed Performance Rate (not risk adjusted; numerator divided by denominator x 100)

11 12 13 14

Agency-Level Data


INTERPRETING YOUR REPORT

Application of % Patients Experiencing One or More Falls with Major Injury

Agency-Level Data


STEPS IN THE REPORT REVIEW PROCESS

#1. Examine your Review & Correct Report agency-level results per measure on a routine basis but not less frequently than monthly and not more than weekly



#2. Review the Agency-Level data for each measure individually. Look for discrepancies between quarters and suspicious data.

Those results for our Falls measure seem really bad.

I want to investigate this further.

But how do I do that?



#3. Understand the measure numerator, denominator, and exclusions to help determine the cause of any issues found on the report.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures.html


2019 NEW MEASURE:% Patients Experiencing One or More Falls with Major Injury

Measure Description

Percentage of quality episodes in which the patient experiences one or more falls with major injury (defined as bone fractures, joint dislocations, closed-head injuries with altered consciousness, or subdural hematoma) during the home health episode.


Numerator

Number of quality episodes in which the patient experienced one or more falls that resulted in major injury during the episode of care.

p

Denominator

Number of home health quality episodes ending with a discharge, transfer, or death during the reporting period, other than those covered by generic or measure-specific exclusions.

Measure Exclusions

Episodes during which the occurrence of falls was not assessed.Episodes where the assessment indicates that a fall occurred AND the number of falls with major injury was not assessed.


J1800 –Any falls since SOC/ROCJ1900 – Number of falls since SOC/ROC

Not Risk Adjusted


PATIENT-LEVEL EXAMPLE% Patients Experiencing One or More Falls with Major Injury

J1800. Has the patient had any falls since the SOC/ROC whichever is more recent?

0. No1. Yes

0

What doI need

to do to succeed?

J1800 = 0-No

OR

If J1800=1-Yes, thenJ1900C = 0

Success!



#4. When there are questions about the Agency-Level data for an individual measure, take a closer look at the Patient-Level data.



321 4 5 6 7 8

Patient-Level Data



X = Triggered (counted in the measure numerator)NT = Not Triggered (not counted in the measure numerator)E = Excluded from the quality measure calculation

Patient-Level Data

© 2

019

OAS

IS A

nsw

ers,

Inc.

90


Which patients triggered for the Application of % Patients Experiencing One or More Falls with Major Injury measure? ~were included in the measure numerator

Mrs. HoneyNT= Not triggered

No fall with major injury

Mr. GeorgeX= Triggered

Had a fall with major injury

Mr. MinnieX= Triggered


#5. From the Patient-Level data, determine which sample of patients to review (a sample of those who triggered, or those who didn’t trigger, or both)

© 2

019

OAS

IS A

nsw

ers,

Inc.

91


#6. Investigate cases to determine WHY they triggered (or why they didn’t trigger) for the measure.

Mrs. HoneyNT= Not triggered

No fall with major injury

You didn’t investigatethis case

Mr. GeorgeX= Triggered


Your investigation revealed that Mr. George was having episodes of hypotension and

fell and fractured his hip.



Your investigation revealedthat Mr. Minnie fell and had askin tear on his arm but no further injuries. Your new clinician didn’t code J1900

accurately.



#6. Determine:

Do you have any records to correct before the data correction deadline?

Do you have any quality improvement actions?

Do you have any staff education actions?

August 15

Q1 (January 1-March 31)

Data Correction Deadline


NT = Not Triggered


1. State OASIS Automation Coordinators (OACs) https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/OASIS-Automation-Coordinators.pdf)\

2. Outcome and Assessment Information Set (OASIS) transition to the Automated Submission and Processing System (ASAP) and OASIS Correction policy https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-15-18.html?DLPage=1&DLEntries=10&DLFilter=OASIS&DLSort=3&DLSortDir=descending• Determining When to Inactivate an Assessment • Deleting Assessments and Files• Types of Corrections an HHA Can Make• Documentation of Corrected Assessments

CMS OASIS DATA CORRECTION RESOURCES


CMS ANNOUNCES THE RELEASE OF THE INTERNET QUALITY IMPROVEMENT AND EVALUATION SYSTEM (IQIES)


DO WE STILL NEED TO USE

THE CASPER QM REPORTS?

~OUTCOME MEASURES~PROCESS MEASURES

~TALLY REPORTS~CASE MIX REPORT


DO WE STILL NEED TO USE THE CASPER QM REPORTS?

Review & Correct Report• Purpose: Review and Correct publicly

reported data for OASIS-based measures

Quality Measure (QM) Reports• Outcome Report, Process Measures Report, Agency Patient-

Related Characteristics (Case Mix) Report, Tally Reports• Purpose: Provides ability to compare measure results between

national reference rates and agency prior performance

Home Health Compare Preview Report• Purpose: Provides measure final results one quarter prior to

public reporting


If I have data from my electronic record or vendor, is there still value in using the CASPER reports?


OAI STEPS TO SUCCESS FOR PUBLIC REPORTING

1. Monitor Review and

Correct Report no less than monthly

2. Understand OASIS data

accuracy and quality

measure definitions

3. Build your

agency’s quality

calendar around the

Data Correction Deadlines

4. Make data corrections

and implement changes timely

BEFORE DATA

CORRECTION DEADLINES

5. Monitor CASPER Reports

and Preview Reports quarterly


OASIS Quality Improvement for data are calculated twice monthly:

Second Saturday of each month: calculations include new OASIS records with a complete episode of care ending during the month that is 3 months before the calculation month (e.g., 11/10/18 calculation will be for records with a complete episode of care ending in August 2018) Fourth Saturday of each month: New, modified, or inactivated OASIS records with a complete episode of care ending during any previously calculated months (e.g., 11/24/18 calculation will be for records with a complete episode of care ending in or prior to August 2018)Review & Correct Reports do NOT follow this schedule

CASPER DATA CALCULATIONS

Review & Correct Reports are Updated:

When reporting quarter ends, the report is available the next calendar day

Available for providers to run with updated data weekly (until the data correction deadline)


HOME HEALTH COMPARE UPDATES


QUALITY MEASURES 2019PUBLICLY REPORTED: HOME HEALTH COMPARE

Reported on Home Health Compare Data Suppressed (Not Reported) on Home Health Compare

NEW MEASURES ADDED1. NEW - Discharge to Community (claims-

based)2. NEW - Medicare Spending Per

Beneficiary (claims-based)3. NEW - Drug Regimen Review

Conducted with Follow-up for Identified Issues

4. NEW - % of Residents or Patients with Pressure Ulcers That Are New or Worsened

MEASURES REMOVEDNone Removed

NOTE ON HOME HEALTH COMPARE PREVIEW REPORT: Measure results for “Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened” will be frozen as of the October 2019 Home Health Compare refresh and will include quality episodes ending Jan 2018-Dec 2018.

NEW MEASURE TO BE ADDEDPotentially Preventable Readmission (PPR) 30-Day Post Discharge from PAC Home Health Measure

NOTE ON HOME HEALTH COMPARE PREVIEW REPORT: October 2018 and January 2019 Home Health Compare Preview Reports noted that CMS is suppressing the data for one or more quarters.

How do I find the home health agency that’s right for me?


POTENTIALLY PREVENTABLE 30-DAY READMISSIONS (PPR)

Includes Medicare FFS patients who were with health stays that begin during the 2‐year observation period% home health stays in which patients who:₋ Had an acute inpatient discharge within

the 30 days before the start of their home health stay AND

₋ Were admitted to an acute care hospital or LTCH for unplanned, potentially preventable readmissions in the 30‐day window beginning two days after home health discharge LOWER RATES

ARE BETTER!


POTENTIALLY PREVENTABLE 30-DAY READMISSIONS (PPR)ON HOME HEALTH COMPARE - JANUARY 2019


NOT INCLUDEDin the January 2019 Home Health Compare Refresh


DISCHARGE TO COMMUNITY

% home health stays in which patients were:₋ Discharged to the community

AND₋ Do not have an unplanned

readmission to an acute care hospital or LTCH in the 31 days and remain alive in the 31 days following discharge to community

Includes Medicare FFS patients with home health stays that begin during the 3‐year observation period

So happy you haven’t needed to

go back to the hospital since we discharged you!



REPORTED CATEGORICALLY:

“Better than National Rate” is best!

DISCHARGE TO COMMUNITYON HOME HEALTH COMPARE - JANUARY 2019

Your Home Health AgencyHome Health Compare - JANUARY 2019


MEDICARE SPENDING PER BENEFICIARY

The assessment of the Medicare spending of a home health agency’s MSPB‐PAC HH episodes, relative to the Medicare spending of the national median home health agency’s MSPB‐PAC HH episodes across the same performance period.

Score < 1 indicates the HHA’s resource use is < national median HHA during the same performance period.

Includes Medicare FFS patients with home health stays during the observation period


MEDICARE SPENDING PER BENEFICIARYON HOME HEALTH COMPARE - JANUARY 2019

Score < 1 indicates the HHA’s resource use is < national median HHA during the same performance period.

Home Health Compare JANUARY 2019 Your Home Health Agency National

Average


DRUG REGIMEN REVIEW CONDUCTED WITH FOLLOW-UP FOR IDENTIFIED ISSUES

OASIS‐based measure: ₋ M2001 Drug Review (M2001)₋ M2003 Medication Follow‐up

(M2003)₋ M2005 Medication Intervention

(M2005)

% home health quality episodes in which:₋ A drug regimen review was

conducted at the start of care or resumption of care AND

₋ Completion of recommended actions from timely follow‐up with a physician occurred

₋ Each time potential clinically significant medication issues were identified throughout that quality episode.

SOC/ROC

SOC/ROC

TRN/DC/Death



DRUG REGIMEN REVIEW CONDUCTED WITH FOLLOW-UP FOR IDENTIFIED ISSUESON HOME HEALTH COMPARE - JANUARY 2019


Home Health Compare

JANUARY 2019

Your Home Health Agency

State Average National Average


PERCENT OF RESIDENTS OR PATIENTS WITH PRESSURE ULCERS THAT ARE NEW OR WORSENED

OASIS‐basedM1313 Worsening in Pressure Ulcer Status – NOT COLLECTED ON OASIS‐D

% home health quality episodes in which patients with a Stage 2‐4 pressure ulcers present at discharge that are new or worsened since the beginning of the quality episode

Per CY2018 Home Health Rule –will be replaced with a modified version of that measure (“Changes in Skin Integrity Post‐Acute Care: Pressure Ulcer/Injury,” effective CY2020 HH QRP)

Discharge


COMPARISON: PRESSURE ULCER MEASURESMeasure “OLD” MEASURE: % of Residents or

Patients with Pressure Ulcers that are New or Worsened

“NEW” MEASURE: Changes in Skin Integrity Post‐Acute Care: Pressure Ulcer/Injury

OASIS Item M1313 M1311Measure Description

% of quality episodes in which the patient has one or more Stage 2‐4 pressure ulcers present at discharge that are new or worsened since the beginning of the quality episode

% of quality episodes in which the patient has one or more Stage 2‐4 pressure ulcers, or an unstageable ulcer, present at discharge that are new or worsened since the beginning of the quality episode

Denominator # of quality episodes, except those excluded # of quality episodes, except those excluded

Denominator Exclusions

• Episodes that end in a death at home• Episodes without an assessment

completed at the start or resumption of care and an assessment completed at the end of care

• If the discharge assessment does not have a usable response for M1313a, M1313b, or M1313c. A valid skip (“^”), when M1306 = “0” (no), is considered a usable response.

• Episodes that end in a death at home or transfer to an inpatient facility

• Episodes without an assessment completed at the start or resumption of care and an assessment completed at discharge

• If the discharge assessment does not have a usable response for M1311a, M1311b, M1311c, M1311d, M1311e or M1311f.

Numerator Assessment at the end of care indicates one or more new or worsened Stage 2‐4 pressure ulcers compared to the start or resumption of care assessment. Where on any assessment: 1. Stage 2 (M1313a) > [0], OR 2. Stage 3 (M1313b) > [0], OR 3. Stage 4 (M1313c) > [0]

Assessment at discharge indicates one or more new or worsened Stage 2‐4 or unstageable pressure ulcers compared to the start or resumption of care assessment. Where on any discharge assessment: 1. Stage 2 (M1311A1) ‐ (M1311A2) > 0, OR2. Stage 3 (M1311B1) ‐ (M1311B2) > 0, OR 3. Stage 4 (M1311C1) ‐ (M1311C2) > 0, OR 4. Unstageable – Non‐removable dressing/device (M1311D1) ‐ (M1311D2) > 0, OR5. Unstageable – Slough and/or eschar (M1311E1) ‐ (M1311E2) > 0, OR6. Unstageable – Deep tissue injury (M1311F1) ‐ (M1311F2) > 0



PERCENT OF RESIDENTS OR PATIENTS WITH PRESSURE ULCERS THAT ARE NEW OR WORSENED


Home Health Compare

JANUARY 2019

Your Home Health Agency

State Average National Average




NEW Quality

Measures

Star Rating

Changes


Quality Measure

(QM) Definitions

CASPER Report

Changes



Reports


Resources to Keep

YOU in the know!


REFERENCES & RESOURCESCY2019 Home Health PPS Final Rule

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices-Items/CMS-1689-FC.html

CASPER HHA Reporting User's Manual https://www.qtso.com/providers/home-health-agency-hha-providers/reference-manuals

Home Health Quality Measure Tableshttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures.html

Home Health Quality Reporting Program Provider Training Slides and Q&As

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Training.html

OASIS Quarterly Q&As https://qtso.cms.gov/providers/home-health-agency-hha-providers/reference-manuals

Risk Adjustment Technical Specificationshttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures.html

Technical Measure and Patient Characteristics Specifications OASIS-Dhttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures.html


ADDITIONAL RESOURCES FROM OAI

INSTANT OASIS AnswersOASIS-D 2019 Version

~The Little Brown Book

Blueprint for OASIS Accuracy

2-Day Training Numerous Locations Nationally

Onsite at Your Agency

Quarterly OASIS Teleconferences

January, April, July & October

www.oasisanswers.com

Don’t Miss the Next Just in Time Webinar!

May 22, 2019

OASIS GG & M Function Items:

Exploring Assessment

& Documentation

Strategies to Minimize Agency

Risk

Don’t Miss the Next Just in Time Webinar!

May 22, 2019

OASIS GG & M Function Items:

Exploring Assessment

& Documentation

Strategies to Minimize Agency

Risk

home health quality 2019 update - wild apricot conference/pp/home h… · pathway to quality...

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