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Is Your QA Team Spending Time Reviewing Low Value OASIS Items That Were Removed Earlier in the Year?

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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