OCEPS/OTASC
Improving Home Health Outcomes through Education and Research

Funded by: Centers for Medicare & Medicaid Services
Project Period: 10/02 - 9/06

Abstract

Objective: To assist the Centers for Medicare & Medicaid Services (CMS) in quality improvement activities in home health care through education and research. Project work focuses on three areas: education/training, public reporting, and outcomes under the new Prospective Payment System (PPS).

Methods, Results, Discussion:
Education/Training: In response to expressed need by the home health industry for additional education and training, CMS has developed a Web-based training product that addresses all Outcome and Assessment Information Set (OASIS) data items and other aspects of standardized data collection and has sponsored satellite broadcasts (followed by Internet-streaming applications) that address specific aspects of data collection or home care clinical care provision. In addition, due to the turnover in CMS-designated state OASIS Education Coordinators (OECs), basic OASIS education has been presented for all OECs, industry representatives, and other home health stakeholders. Examples of the applications will be presented. Division of Health Care Policy and Research (HCPR) staff has prepared content and other instructional materials, provided assistance and support to other contractors such as video film-makers, coached presenters and actors, and presented material at conferences and via satellite broadcasts.
Public Reporting: As part of the CMS Home Health Quality Initiative, quality measures based on patient outcomes are published for Medicare-certified home health agencies so that consumers (e.g., Medicare beneficiaries and their families, referring physicians, and hospital discharge planners) can compare an agency's performance to state and national averages and to other agencies. Agency outcome rates are risk-adjusted for differences in case mix, and aggregated to represent performance over a 12-month period. The outcome measures and risk adjustment methodology were developed by HCPR under an earlier CMS-funded quality improvement demonstration, and HCPR staff contributed significantly to the design of the public reporting system. Agency, state, and national trends will be monitored to ascertain whether public reporting of quality measures encourages performance improvement.
Outcomes under the Home Health Prospective Payment System (PPS): To examine home health outcome changes in the first year of PPS, a national sample of 165,000 episodes from pre-PPS (1999-2000) and early PPS (2001) periods was selected. The 41 outcomes available in CMS reports were analyzed with risk models used by CMS. Outcome changes (statistically significant) were mixed. Favorable changes under PPS were higher improvement rates for functioning and dyspnea, higher community discharge rates, and lower hospitalization and emergent care rates. Unfavorable changes were lower improvement rates for wounds, incontinence, cognitive and emotional/behavioral outcomes. Since the findings pertain to the first PPS year, longer-term studies are needed, but the possible decline in some outcomes is of concern.

Key Staff: Schlenker, Hittle, Crisler, Baillie, Conway, Goodrich, Nuccio, Powell, Richard

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