Understanding Home Health Quality Measures: A Detailed List for Care Providers

As a home care professional, ensuring the highest quality of patient care is paramount. The Home Health Quality Reporting Program (HH QRP) is a critical initiative designed to measure and report the quality of care provided by home health agencies. This program utilizes a variety of quality measures to give a comprehensive view of agency performance. Understanding these measures is crucial for agencies striving for excellence and for patients seeking the best possible care.

This article delves into the types of quality measures used within the HH QRP, providing a clear and detailed overview for home health professionals. We will explore outcome measures, process measures, and patient-reported outcome measures, clarifying how each contributes to the overall assessment of home health care quality.

Types of Home Health Quality Measures

The HH QRP uses three main categories of quality measures to evaluate home health agencies:

1. Outcome Measures: These measures assess the tangible results of healthcare experienced by patients. They look at the impact of care on a patient’s health status. Data for outcome measures comes from two primary sources:

   • OASIS (Outcome and Assessment Information Set): This data is submitted by home health agencies and captures patient assessments at various points in care. OASIS-based measures typically focus on a completed episode of care, from admission to discharge or transfer.
   • Medicare Claims Data: Claims data provides another layer of information, particularly for claims-based measures which evaluate utilization and cost over specific timeframes.

   Many outcome measures are risk-adjusted to account for differences in patient populations served by different agencies. This risk adjustment ensures a fairer comparison between agencies by considering patient characteristics and complexities.

   Home health outcome measures are further categorized into four types:

   • Improvement Measures: These reflect a patient’s progress in areas like mobility, daily living activities, and overall health. Positive changes in these areas indicate effective care.
   • Measures of Potentially Avoidable Events: These act as indicators of potential issues in care delivery. Monitoring these events helps identify areas for improvement and prevent negative outcomes.
   • Utilization of Care Measures: These assess how often patients use other healthcare resources, such as hospitals or emergency rooms, during or after home health care. Lower utilization rates can suggest more effective home-based care management.
   • Cost/Resource Measures: These measures evaluate the cost-effectiveness of care, examining resource utilization in relation to patient outcomes.

   For a complete list of home health outcome measures, refer to the Home Health Outcome Measures Table. This table provides detailed information on each measure and its specifications.

2. Process Measures: Process measures evaluate whether home health agencies are consistently using recommended, evidence-based care processes. These measures focus on the delivery of care and adherence to best practices. The HH QRP process measures target areas considered high-risk, high-volume, or prone to problems in home health care. A key example is the timeliness of home care admission.

   Like outcome measures, process measures are derived from OASIS data and calculated based on completed quality episodes. However, unlike outcome measures, process measures are generally not risk-adjusted. The rationale is that the measured processes are considered appropriate for all patients within the defined population for each measure. Patients for whom a process is not relevant are excluded from the measure calculation.

   Key Home Health Process Measures include:

   • Timely Initiation of Care: Ensures patients receive necessary care promptly after referral.
   • Percent of Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function: Focuses on comprehensive assessment and care planning to address patient functional needs.
   • Influenza Immunization Measures: Tracks the provision of influenza immunizations to patients, including instances where immunization is received, offered and refused, or contraindicated.
   • Drug Regimen Review Conducted with Follow-Up for Identified Issues: Emphasizes medication safety and management through regular reviews and follow-up actions.
   • Transfer of Health Information to the Patient and to the Provider: Highlights the importance of clear and effective communication of patient health information during care transitions.

   Detailed information on each of these process measures can be found in the Home Health Process Measures Table. Technical specifications for calculating process measures are available in the Technical Documentation of OASIS-Based Measures.

3. Patient Reported Outcome Measures: These measures capture the patient’s perspective on their care experience. The HHCAHPS (Home Health Consumer Assessment of Healthcare Providers and Systems) survey is the instrument used to collect this data. This standardized 34-question survey gathers feedback from current or recently discharged home health patients (or their family or friends) about their experiences with the agency.

   HHCAHPS is significant because it:

   • Provides a national standard for measuring patient experience in home health.
   • Allows for valid comparisons between home health agencies based on patient feedback.
   • Uses a core set of questions, while also allowing agencies to add custom questions for internal quality improvement.

   CMS groups HHCAHPS measures into composite and overall measures, publicly reported as “patient survey results” on the Care Compare website. The five key measure areas are:

   • Care of Patients: Evaluates the quality and effectiveness of the direct care provided.
   • Communications between Providers and Patients: Assesses the clarity and effectiveness of communication.
   • Specific Care Issues: Addresses specific aspects of care, such as medication management and pain management.
   • Overall Rating of Care: Captures the patient’s overall satisfaction with the home health agency.
   • Patient willingness to recommend HHA to family and friends: A crucial measure of patient loyalty and satisfaction.

   For more in-depth information on HHCAHPS, including the survey instrument, visit https://homehealthcahps.org/.

Data Sources for HH QRP Measures

The HH QRP leverages multiple data sources to calculate quality measures, ensuring a robust and comprehensive assessment. These sources include:

• OASIS Assessment Data: Provides detailed clinical information about patients, crucial for both outcome and process measures.
• Medicare Fee-for-Service (FFS) Claims Data: Offers data on healthcare utilization and costs, particularly for claims-based measures.
• HHCAHPS Survey Data: Captures patient experience feedback, forming the basis for patient-reported outcome measures.

Participation in OASIS and HHCAHPS data collection and reporting is mandatory for home health agencies participating in the HH QRP. Medicare FFS claims data is automatically submitted by HHAs for payment purposes.

Assessment-Based vs. Claims-Based Measures

Within the HH QRP, measures are further categorized by their data source:

• Assessment-based measures: The majority of HH QRP measures fall into this category, utilizing OASIS data. These can be either process or outcome measures. OASIS-based process measures are not risk-adjusted, focusing on adherence to recommended care processes. OASIS-based outcome measures are risk-adjusted to account for patient variations.

• Claims-based measures: These are a subset of outcome measures calculated from Medicare FFS claims data. They fall into two main types:

  • Claims-based utilization measures: Focus on healthcare service utilization, such as hospitalizations and emergency department visits, reflecting changes in patient health status.
  • Claims-based cost/resource use measures: Assess the cost-effectiveness of care, like Medicare Spending per Beneficiary – Post-Acute Care (MSPB-PAC) Home Health.

Claims-Based Utilization Measures in Detail

Claims-based utilization measures provide valuable insights into patient outcomes by tracking healthcare service usage following home health care initiation. These measures often look at negative events, such as hospitalizations or emergency department visits, or the absence of such events (e.g., Discharge to Community). Lower values for these measures generally indicate better patient outcomes, reflecting fewer adverse events after receiving home health care.

The five claims-based utilization measures are:

1. Acute Care Hospitalization During the First 60 days of Home Health (ACH): Measures hospitalizations within the initial 60 days of home health care.
2. Emergency Department (ED) Use without Hospitalization During the First 60 Days of Home Health: Tracks ED visits that do not result in hospitalization within the first 60 days.
3. Discharge to Community (DTC): Indicates successful discharge to a community setting rather than requiring institutionalization.
4. Potentially Preventable 30-Day Post-Discharge Readmission (PPR): Measures readmissions to the hospital within 30 days of home health discharge, potentially indicating areas for improved care transitions.
5. Home Health Within-Stay Potentially Preventable Hospitalization (PPH): Tracks hospitalizations occurring while the patient is still receiving home health services.

Claims-Based Cost/Resource Use Measure

The HH QRP includes one key claims-based cost/resource use measure:

• Medicare Spending per Beneficiary – Post-Acute Care (MSPB-PAC) Home Health: This measure compares a home health agency’s Medicare spending to the national average for home health agencies during the same period. It provides an indication of cost-efficiency.

Home Health Measures Outside the HH QRP: Potentially Avoidable Events (PAEs)

It’s important to note that Potentially Avoidable Event (PAE) measures, while derived from OASIS data like many HH QRP measures, are not part of the HH QRP itself. PAEs were developed under the Outcome-Based Quality Improvement (OBQI) initiative, preceding the HH QRP.

PAE measures serve as markers for potential care problems due to their negative nature and relatively low occurrence. They are outcome measures, reflecting changes in health status between care initiation and discharge. All PAE measures are risk-adjusted. While not publicly reported on Care Compare, PAE data is available to HHAs through IQIES reports for internal quality improvement efforts.

For a list of PAE measures, consult the Home Health PAE Measures Table. Technical documentation is available in the Technical Documentation of OASIS-Based Measures. The Outcome-Based Quality Monitoring Manual provides further information on PAE measures.

Understanding the full spectrum of quality measures used in home health care, including outcome, process, and patient-reported measures, as well as assessment-based and claims-based distinctions, is essential for home health agencies committed to providing high-quality, patient-centered care. By focusing on these measures, agencies can identify areas for improvement, enhance patient outcomes, and contribute to a more effective and efficient home health system.