Program to Provide Information on Quality of Home Health Care Providers

Feb. 22, 2003 - This spring the Department of Health and Human Services will begin the development of a program to provide Medicare and Medicaid consumers with information they can use in selecting a home health agency.

The new home health consumer information resource, "Home Health Compare," will expand and strengthen CMS' existing beneficiary-oriented comparison tools - including "Medicare Health Plan Compare," "Dialysis Facility Compare" and "Nursing Home Compare," which are all on the Web at http://www.medicare.gov.

HHS' Centers for Medicare & Medicaid Services (CMS) will begin the first phase of the home health quality initiative with eight states - Florida, Massachusetts, Missouri, New Mexico, Oregon, South Carolina, Wisconsin and West Virginia. CMS will begin publishing the quality information about home health agencies in these eight states to help make people aware of how performance differs across agencies and to help stimulate home health agency quality improvement, said HHS Secretary Tommy G. Thompson as he announced the new home health quality initiative this week.

"We will give consumers the information that they need to compare home health agencies based on quality and to make sound choices about their care," Secretary Thompson said. "As we've learned during our similar nursing home initiative, giving consumers and healthcare providers this kind of data creates powerful incentives to improve the quality of care provided to patients."

The information will be available in newspapers in the eight states and online at http://www.medicare.gov and will be promoted through CMS' local Quality Improvement Organizations (QIOs).

A key part of the initiative is the public reporting of 11 quality measures. The quality measures for the new home health initiative are a subset of the 41 Outcomes and Assessment Information Set (OASIS) outcome measures that have been used by home health agencies since 1999. The OASIS is collected by home health agency staff at start of care, discharge or transfer, at follow up (60 day re-certification) and at resumption of care.

Another important part of the initiative is the quality improvement activities that the QIOs will engage in with home health agencies, as well as the QIO's assistance to consumers in helping them better use the quality performance data. Over the past three years, a pilot group of five QIOs successfully implemented a quality improvement program with home health agencies in their state. This program successfully piloted the quality improvement strategy called the Outcomes Based Quality Improvement (OBQI) System.

During the year, CMS will refine and expand the initiative to include quality information for home health agencies in all 50 states in fall 2003.

"Most people with Medicare and Medicaid coverage prefer to remain in their homes rather than being in a nursing home or other institution, whenever possible," CMS Administrator Tom Scully said. "It is our responsibility to provide people who rely on home health care with the most up-to-date information available about the quality of care and give them tools to decide which home health provider can best meet their needs."

CMS consulted with HHS' Agency for Healthcare Research and Quality as it identified appropriate quality measures to use for this initiative. The measures were chosen with input from measurement experts and a diverse group of home health professionals, clinicians and stakeholders. The quality measures include:

four measures related to improvement in getting around (getting better at walking and moving around using less equipment, getting in and out of bed without help, and getting to and from the toilet without help, and having less pain when moving around),
four measures related to improvement in meeting basic daily needs (getting better at bathing, taking medicines and dressing the upper part of their body without help, and staying the same at bathing without help),
two measures related to medical emergencies (had to be admitted to the hospital and needed emergency medical care), and
one measure related to improvement in mental health (being confused less often).

"We already collect extensive data on every home health patient in the country through our OASIS measures, and AHRQ helped us identify the quality measures that would be most useful to patients and their families," Scully said. "We found in nursing homes that quality comparisons not only help patients, but they create a 'buzz' about quality among nursing home staff and administrators that is very positive."

To support CMS's evolutionary process of improving the home health quality measures, the National Quality Forum (NQF) will work with CMS later in this project. Specifically, in late 2003 NQF will convene a Home Health Steering Committee and begin their consensus process. The group will use lessons from the CMS initiative and bring together consumers, purchasers, researchers, clinicians, providers and others across the public and private sectors to develop consensus on a core set of standard quality measures.

The information will also be available at 1-800-MEDICARE (1-800-633-4273).

The initiative reflects the administration's continued commitment to improving the quality of health care in all aspects of the Medicare and Medicaid programs, said the announcement.