In 2008, there were over 9000 Medicare certified home health agencies throughout the United States. In 2006, over 3 million beneficiaries were served, and 103,931,188 visits made.

Home health is covered under the Part A Medicare benefit. It consists of part-time, medically necessary skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) that is ordered by a physician.

Quality health care for people with Medicare is a high priority for the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services (CMS).

CMS has adopted the mission of The Institute of Medicine (IOM) who has defined quality as having the following properties or domains:

Effectiveness. Relates to providing care processes and achieving outcomes as supported by scientific evidence.

Efficiency. Relates to maximizing the quality of a comparable unit of health care delivered or unit of health benefit achieved for a given unit of health care resources used.

Equity. Relates to providing health care of equal quality to those who may differ in personal characteristics other than their clinical condition or preferences for care.

Patient Centeredness. Relates to meeting patients' needs and preferences and providing education and support.

Safety. Relates to actual or potential bodily harm.

Timeliness. Relates to obtaining needed care while minimizing delays.

The instrument/data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS). Since fall 2003, CMS has posted on www.medicare.gov a subset of OASIS-based quality performance information showing how well home health agencies assist their patients in regaining or maintaining their ability to function.

Based on the 2005 NQF endorsement, as of 12/2007 12 of these measures have been posted to Home Health Compare. The measures (all collected via the OASIS data set) are:

• Improvement in Ambulation/Locomotion
• Improvement in Bathing
• Improvement in Transferring
• Improvement in Management of Oral Medication
• Improvement in Pain Interring with Activity
• Acute Care Hospitalization
• Emergent Care
• Discharge to Community
• Improvement in Dyspnea (Shortness of Breath)
• Improvement in Urinary Incontinence
• Improvement in Surgical Wound Status, and
• Emergent Care for Wound Deterioration

At the request of CMS, *NQF will review for potential endorsement a set of refined and newly developed home health measures in particular process measures for immunization, medication management, pain management, fall prevention, depression screening/intervention, care coordination, risk assessment, heart failure, and diabetes.These measures were tested in the revised OASIS tool.
(See OASIS C link in the left column.)

NQF also will look to harmonize the home health measures with similar NQF-endorsed TM measures in other care settings (e.g., ambulatory, hospital, and nursing homes). NQF will work in partnership with the Agency for Healthcare Research and Quality (AHRQ) and CMS, the accrediting entities, alliances, and representatives from major stakeholder groups to establish priorities and identify a set of national goals, measures corresponding to each goal and a framework for accountability.

It is too early to know exactly how these changing priorities may impact the entire health care system. Planning/discussions are in a preliminary phase. Pay for performance logically will link to Value and Efficiency and actual activities and efforts of providers - using evidence-based practices and systems (in the form of process measures that will be collected at the agency level) - to promote use of such practices. Providers, consumers, and interested parties, such as the many organizations that represent and work with patients in post-acute, home, community, and long-term care settings will be part of these efforts as they evolve. As we look to become stewards of the Medicare trusts funds those that are quality and mission driven while maintaining some efficiencies will become increasingly important in transforming the healthcare system.

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Related Links Inside CMS
FAQs Medicare.gov Home Health Compare
Related Links Outside CMS
Agency for Healthcare Research & Quality American Association of Home Care National Association for Home Care and Hospice National Association State Units on Aging National Quality Guidelines National Pressure Ulcer Advisory Panel Quality Improvement Organizations (QIOs- resources to assist home health agencies seeking to improve performance on the quality measures.) Visiting Nurse Association of America Wound Ostomy Continence Nurses Society

Page Last Modified: 12/02/2008 9:34:35 AM
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