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ast month, this column explored how the Centers for Medicare and Medicaid Services (CMS) is using Outcome and Assessment Information Set (OASIS) data to determine how every home healthcare agency compares to the national average in terms of the incidence rates of adverse events. This month’s column will look at other OASIS-based indicators that CMS is focusing on in its well-publicized Home Health Quality Initiative (details of which are available at http://www.cms.hhs.gov/quality/hhqi).
       There are 11 publicly reported quality measures known collectively as the home health agency report card, and they identify outcomes that are meaningful to virtually all home health patients. Here is how they are grouped: 4 measures relate to improvement in mobility, 4 relate to the patient’s activities of daily living, 2 relate to patient medical emergencies, and 1 relates to improvement in mental health. A comparison of how home health agencies in each community stack up to each other can be accessed on the CMS Home Care Compare website at http://www.medicare.gov/HHCompare.
       The Centers for Medicare and Medicaid Services is making this information public in order to provide consumers with objective information about how local agencies compare to each other in terms of patient outcomes. The organization also expects that it will encourage home health agencies to focus quality improvement efforts on these indicators. See Table 1 for a list of all 11 outcome measures.

Table 1

       This month’s column will outline how home health agencies can analyze these reports and integrate them into their performance improvement plans, also touching on how they can be used to market your home health agency.
       With more than 80 OASIS questions asked on admission, where do these measures originate? The 11 publicly reported measures are obtained by comparing changes in each patient’s health status from admission to discharge and determining if he or she improved, stabilized, or declined (they may also come from OASIS data obtained on recertification and at hospitalization). These changes can occur as the result of the care provided by the home health agency or as the result of the natural progression of the patient’s illness. To help ensure the changes result from care provided by the home health agency, CMS risk-adjusts the measures to attempt to compensate for variations between patients seen by 1 home health agency and others in the same community. If, for example, a home health agency admitted older, poorer patients than its competition, these demographics would need to be considered in evaluating outcomes. Essentially, risk adjustments are CMS’s approach to considering these variations when assigning values to each indicator.
       How should home health agencies react? After all, agencies are not required by law to consider these measures. Smart home health agencies, however, understand that this information can be used to differentiate themselves from the competition in a whole new way. If you are working for 1 of these forward-looking home health agencies, your team can begin by comparing your results in these 11 measures to the local and national averages for each outcome. Depending on your population and other local factors, you can then determine which should be priorities for improvement; you will probably pick 1 or more that are likely to have the greatest impact on improving the care your home health agency provides to the patients in the community.
       As a way to gain insight into whether a facility is above or below its competition, organizations can evaluate the effectiveness of the care provided by reviewing the medical records of individual patients‚ paying special attention to the skilled notes and documentation of care planning activities. Depending on what they find, facilities can develop and implement action plans to improve the targeted outcomes. After implementation, they would then monitor subsequent Home Care Compare reports to see how well the plans worked, tweaking them to continue to improve outcomes whenever opportunities appear. This entire process is called outcomes-based quality improvement (OBQI) and represents a systematic approach to continuously improving the quality of care provided to patients.
       Though not yet required by CMS, this approach will likely improve publicly reported outcomes and can easily be integrated into the home health agency’s performance improvement plans. Agencies do not have to conduct the analysis and monitoring on their own; in every state, CMS has employed quality improvement organizations to monitor and assist hospitals, skilled nursing facilities, and home health agencies in this process. When you figure out where you shine in these outcome measures, you can use the information to show why patients and physicians should consider your agency when selecting a provider of home healthcare.

Frequently Asked Questions

       Question: I know that immediately after surgery, an incision should be considered a surgical wound, but for how long?
       Answer: According to the Wound, Ostomy, and Continence Nurses Society (WOCN) OASIS guidance document,¹ when a surgical site becomes fully epithelialized, is free of any necrotic tissue or signs of inflammation, and the healing ridge resolves, the surgical site wound will no longer be a wound but would then be a surgical scar. For closed incisions healing without any signs of complication, the status of the healing ridge seems to be a good basis for making the determination. The healing ridge typically appears between post-operative Day 5 and 9, resolving by post-operative Day 15.
       Question: In reviewing records from my case mix and adverse event report, I sometimes find patients who technically “required emergent care,” but my review of the skilled notes shows that the clinicians were simply acting appropriately on a sudden change in condition. Is this really an adverse event?
       Answer: No, this is not an adverse event, because your review of the record confirmed that it was not. That is why CMS has been careful to tell home health agencies and regulators that these reports show potential adverse events that must be confirmed or refuted by chart audits like yours.

Do you have questions?

If you have a question that you would like addressed in “OASIS: More Than Just an Assessment,” e-mail it to Ryan Dougherty, Senior Editor, at ryand@hmpcommunications.com, and we will address it in a future issue of ECPN.