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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
© 2019 OASIS Answers, Inc. 3
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!
OASIS Answers Annual COS‐C Conference September 25, 2018
© 2019 OASIS Answers, Inc. 4
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
© 2019 OASIS Answers, Inc. 5
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!
© 2019 OASIS Answers, Inc. 6
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
© 2019 OASIS Answers, Inc.
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
© 2019 OASIS Answers, Inc. 8
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
© 2019 OASIS Answers, Inc. 9
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!
OASIS Answers Annual COS‐C Conference September 25, 2018
© 2019 OASIS Answers, Inc. 10
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 OASIS Answers, Inc. 11
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
© 2019 OASIS Answers, Inc. 12
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
© 2019 OASIS Answers, Inc. 13
PATIENT-LEVEL EXAMPLEChanges in Skin Integrity Post-Acute Care: Pressure Ulcers/Injuries
What doI need
to do to succeed?
Success!
1
1
© 2019 OASIS Answers, Inc. 14
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.
LOWER RATES ARE BETTER!
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.
OASIS Item Used to Calculate this Measure:
J1800 –Any falls since SOC/ROCJ1900 – Number of falls since SOC/ROC
Not Risk Adjusted
© 2019 OASIS Answers, Inc. 15
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 OASIS Answers, Inc. 16
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)
© 2019 OASIS Answers, Inc. 18
% 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
© 2019 OASIS Answers, Inc. 19
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!
© 2019 OASIS Answers, Inc.
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
© 2019 OASIS Answers, Inc.
(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
© 2019 OASIS Answers, Inc.
(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
© 2019 OASIS Answers, Inc.
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
© 2019 OASIS Answers, Inc.
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.
© 2019 OASIS Answers, Inc.
NEW - HHVBP MEASURES ARE WEIGHTED
25
CMS Home Health CY2019 PPS Final Rule
HHVBP
© 2019 OASIS Answers, Inc. 26
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
© 2019 OASIS Answers, Inc. 27
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!
© 2019 OASIS Answers, Inc. 28
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
© 2019 OASIS Answers, Inc. 29
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
© 2019 OASIS Answers, Inc. 30
QOPC STAR RATINGSTATE & NATIONAL DISTRIBUTIONS
“CLICK” to reveal graphs of distribution of state and national star ratings
© 2019 OASIS Answers, Inc. 31
QOPC STAR RATINGSTATE RESULTS
Agency #1Agency #2Agency #3
© 2019 OASIS Answers, Inc. 32
QOPC STAR RATINGNATIONAL RESULTS
Agency #1Agency #2Agency #3
© 2019 OASIS Answers, Inc.
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
© 2019 OASIS Answers, Inc. 34
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
© 2019 OASIS Answers, Inc. 35
QOPC STAR RATING-PROVIDER PREVIEW REPORT SCORECARD
© 2019 OASIS Answers, Inc. 36
QUALITY OF PATIENT CARE STAR RATINGRESOURCES https://www.cms.gov/Medicare/Quality-
Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings.html
© 2019 OASIS Answers, Inc.
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.
© 2019 OASIS Answers, Inc. 38
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
© 2019 OASIS Answers, Inc.
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.
© 2019 OASIS Answers, Inc.
© 2019 OASIS Answers, Inc.
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
© 2019 OASIS Answers, Inc. 42
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
Uses:Quality of Patient Care Star Rating &HHVBPConsumer Language
How often patients got better at getting in and out of bed. NA
Type Outcome Measure – End Result Composite
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.
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 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
© 2019 OASIS Answers, Inc. 44
MEASURE: IMPROVEMENT IN AMBULATION/LOCOMOTION
Uses:Quality of Patient Care Star Rating &HHVBPConsumer Language
How often patients got better at walking or moving around.
NA
Type Outcome Measure – End Result Composite
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.
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 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
© 2019 OASIS Answers, Inc.
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)
© 2019 OASIS Answers, Inc.
© 2019 OASIS Answers, Inc.
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
© 2019 OASIS Answers, Inc.
© 2019 OASIS Answers, Inc. 47
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!
© 2019 OASIS Answers, Inc. 48
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.
© 2019 OASIS Answers, Inc. 49
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…
© 2019 OASIS Answers, Inc. 50
© 2019 OASIS Answers, Inc. 51
© 2019 OASIS Answers, Inc. 52
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!
© 2019 OASIS Answers, Inc. 53
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…
© 2019 OASIS Answers, Inc. 54
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
© 2019 OASIS Answers, Inc. 55
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)
CASPER QUALITY MEASURE REPORTS:AGENCY PATIENT-RELATED CHARACTERISTIC (CASE MIX) REPORT
© 2019 OASIS Answers, Inc. 56
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
CASPER QUALITY MEASURE REPORTS:AGENCY PATIENT-RELATED CHARACTERISTIC (CASE MIX) REPORT
© 2019 OASIS Answers, Inc. 57
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
CASPER QUALITY MEASURE REPORTS:AGENCY PATIENT-RELATED CHARACTERISTIC (CASE MIX) REPORT
© 2019 OASIS Answers, Inc. 58
Pages 2‐3 contain new characteristics for Functional Abilities calculated from GG0100 Prior FunctioningGG0110 Prior Device UseGG0130 Self‐CareGG0170 Mobility
CASPER QUALITY MEASURE REPORTS:AGENCY PATIENT-RELATED CHARACTERISTIC (CASE MIX) REPORT
© 2019 OASIS Answers, Inc. 59
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
CASPER QUALITY MEASURE REPORTS:AGENCY PATIENT-RELATED CHARACTERISTIC (CASE MIX) REPORT
© 2019 OASIS Answers, Inc. 60
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
© 2019 OASIS Answers, Inc. 61
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
© 2019 OASIS Answers, Inc.
Pages 1‐3Risk‐Adjusted OASIS‐BasedEnd Result Outcomes
CASPER QUALITY MEASURE REPORTS:OUTCOME REPORT
Page 4Non‐ Risk‐AdjustedOASIS‐Based End Result Outcomes
62
Utilization Outcome
Page 5Risk‐Adjusted OASIS‐BasedUtilization Outcome
CASPER QUALITY MEASURE REPORTS:OUTCOME REPORT
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
© 2019 OASIS Answers, Inc.
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Outcome Report(beginning January 2019)
NEW MEASURES ADDEDNone
MEASURES REMOVED
1. Acute Care Hospitalization (OASIS-based)
2. Emergency Dept Use with Hospitalization (OASIS-based)
© 2019 OASIS Answers, Inc. 65
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
© 2019 OASIS Answers, Inc. 66
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
© 2019 OASIS Answers, Inc. 67
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.
© 2019 OASIS Answers, Inc. 68
REVIEW & CORRECT REPORT EVOLUTIONApril 2017: Agency-Level Data ONLY
April 2019Agency-Level & Patient-Level Data
New feature in April 2019!!!Patient-Level data
© 2019 OASIS Answers, Inc. 69
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
© 2019 OASIS Answers, Inc. 70
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
© 2019 OASIS Answers, Inc. 71
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
OASIS Answers Annual COS‐C Conference September 25, 2018
© 2019 OASIS Answers, Inc. 72
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?
OASIS Answers Annual COS‐C Conference September 25, 2018
© 2019 OASIS Answers, Inc. 73
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.
OASIS Answers Annual COS‐C Conference September 25, 2018
© 2019 OASIS Answers, Inc. 74
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
OASIS Answers Annual COS‐C Conference September 25, 2018
© 2019 OASIS Answers, Inc. 75
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
© 2019 OASIS Answers, Inc. 76
REVIEW & CORRECT REPORT OPTIONS
Agency-Level Data
Patient-Level Data
© 2019 OASIS Answers, Inc. 77
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
© 2019 OASIS Answers, Inc. 78
REVIEW & CORRECT REPORT OVERVIEW
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
© 2019 OASIS Answers, Inc. 79
REVIEW & CORRECT REPORT OVERVIEW
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
© 2019 OASIS Answers, Inc. 80
REVIEW & CORRECT REPORT OVERVIEW
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
© 2019 OASIS Answers, Inc. 81
INTERPRETING YOUR REPORT
Application of % Patients Experiencing One or More Falls with Major Injury
Agency-Level Data
© 2019 OASIS Answers, Inc. 82
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
© 2019 OASIS Answers, Inc. 83
STEPS IN THE REPORT REVIEW PROCESS
#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?
© 2019 OASIS Answers, Inc. 84
STEPS IN THE REPORT REVIEW PROCESS
#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 OASIS Answers, Inc. 85
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.
LOWER RATES ARE BETTER!
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.
OASIS Item Used to Calculate this Measure:
J1800 –Any falls since SOC/ROCJ1900 – Number of falls since SOC/ROC
Not Risk Adjusted
© 2019 OASIS Answers, Inc. 86
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 OASIS Answers, Inc. 87
STEPS IN THE REPORT REVIEW PROCESS
#4. When there are questions about the Agency-Level data for an individual measure, take a closer look at the Patient-Level data.
© 2019 OASIS Answers, Inc. 88
REVIEW & CORRECT REPORT OVERVIEW
321 4 5 6 7 8
Patient-Level Data
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REVIEW & CORRECT REPORT OVERVIEW
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
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STEPS IN THE REPORT REVIEW PROCESS
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
Had a fall with major injury
#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)
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STEPS IN THE REPORT REVIEW PROCESS
#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
Had a fall with major injury
Your investigation revealed that Mr. George was having episodes of hypotension and
fell and fractured his hip.
Mr. MinnieX= Triggered
Had a fall with major injury
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.
© 2019 OASIS Answers, Inc. 92
STEPS IN THE REPORT REVIEW PROCESS
#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
Mr. MinnieX= Triggered
NT = Not Triggered
© 2019 OASIS Answers, Inc. 93
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
© 2019 OASIS Answers, Inc. 94
CMS ANNOUNCES THE RELEASE OF THE INTERNET QUALITY IMPROVEMENT AND EVALUATION SYSTEM (IQIES)
© 2019 OASIS Answers, Inc. 95
DO WE STILL NEED TO USE
THE CASPER QM REPORTS?
~OUTCOME MEASURES~PROCESS MEASURES
~TALLY REPORTS~CASE MIX REPORT
© 2019 OASIS Answers, Inc. 96
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
© 2019 OASIS Answers, Inc. 97
If I have data from my electronic record or vendor, is there still value in using the CASPER reports?
© 2019 OASIS Answers, Inc. 98
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
© 2019 OASIS Answers, Inc. 99
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)
© 2019 OASIS Answers, Inc. 100
HOME HEALTH COMPARE UPDATES
© 2019 OASIS Answers, Inc. 101
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?
© 2019 OASIS Answers, Inc. 102
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!
© 2019 OASIS Answers, Inc. 103
POTENTIALLY PREVENTABLE 30-DAY READMISSIONS (PPR)ON HOME HEALTH COMPARE - JANUARY 2019
LOWER RATES ARE BETTER!
NOT INCLUDEDin the January 2019 Home Health Compare Refresh
© 2019 OASIS Answers, Inc. 104
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!
HIGHER RATES ARE BETTER!
© 2019 OASIS Answers, Inc. 105
REPORTED CATEGORICALLY:
“Better than National Rate” is best!
DISCHARGE TO COMMUNITYON HOME HEALTH COMPARE - JANUARY 2019
Your Home Health AgencyHome Health Compare - JANUARY 2019
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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
© 2019 OASIS Answers, Inc. 107
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
© 2019 OASIS Answers, Inc. 108
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
HIGHER RATES ARE BETTER!
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DRUG REGIMEN REVIEW CONDUCTED WITH FOLLOW-UP FOR IDENTIFIED ISSUESON HOME HEALTH COMPARE - JANUARY 2019
HIGHER RATES ARE BETTER!
Home Health Compare
JANUARY 2019
Your Home Health Agency
State Average National Average
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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
LOWER RATES ARE BETTER!
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
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PERCENT OF RESIDENTS OR PATIENTS WITH PRESSURE ULCERS THAT ARE NEW OR WORSENED
LOWER RATES ARE BETTER!
Home Health Compare
JANUARY 2019
Your Home Health Agency
State Average National Average
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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!
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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
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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
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