Transcript oasis - HHQI

Home Health and the 11th SoW
Today’s Presentation
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Culture of Home Health
HHQI Overview
QIN-QIOs Assistance
Q&A and Next Steps
Patient-Centered Care
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Value of Home Health
Build trust and relationships
Identify adherence issues or barriers
Activate and engage patient
Teach self-management skills
Provide cross-setting communications
Demographics of Home Health Users
Avalere Home Health Chartbook (2013)
Top Home Health Diagnoses
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Diabetes mellitus
Care involving use of rehabilitation procedures
Essential hypertension
Other ortho aftercare
Other, and unspecified aftercare
Heart failure
Avalere Home Health Chartbook (2013)
Medicare Home Health Criteria
1. Physician orders
– Plan of Care
– Face-to-Face Encounter
2. Skilled Care
– Intermittent skilled nursing care
– Physical therapy
• Occupational therapy cannot
initiate care, but can continue
care
– Speech-language pathology
services
3. Medicare-certified
Home Health Agency
4. Homebound
– See next slide for new
rules effective 11/19/13
– Note: Medicaid and
other payers don’t
require homebound
Centers for Medicare & Medicaid Services
http://www.medicare.gov/pubs/pdf/10969.pdf
Medicare Home Health Criteria
Criteria-One
Criteria-Two
 Because of illness or injury, need
the aid of supportive devices such
as crutches, canes, wheelchairs,
and walkers; the use of special
transportation; or the assistance of
another person in order to leave
their place of residence;
OR
 Have a condition such that leaving
his or her home is medically
contraindicated.
 If the patient meets one of the
Criteria-One conditions, then the
patient must ALSO meet two
additional requirements defined in
Criteria-Two .
 There must exist a normal inability
to leave home;
AND
 Leaving home must require a
considerable and taxing effort.
Changes as of 11/19/13
Determined by Outcome and Assessment
Information Set (OASIS) Evolution
Conditions
of
Participation
Enhanced
Surveys
Process
Quality
Measures
Internal
Benchmarking
OASIS
Home
Health
Compare
OBQI
(Beginning
of CASPER)
OBQM
(Potentially
Avoidable
Events)
PPS
(Payment)
OASIS is Foundational
 OASIS-C1/ICD-9 changes go into effect
01/01/15
– OASIS submission system will shut down on
12/26/14 at 6 pm (ET)
– New OASIS ASAP system will be available on
01/01/215 at 12 am (ET)
 OASIS-C1/ICD-10 changes go into effect
10/01/15
 Integral part of the proposed new Conditions
of Participation (CoP)
Prospective Payment System (PPS)
 Predetermined base payment is adjusted
based upon health condition and care needs
– Specific OASIS items
 Additional adjustments (e.g., Case-Mix
Adjustment, Outlier Payments, LUPA, Rural
Add On, etc.)
OASIS Items for Payment
 Numerous assessment items include
– Clinical
• Examples: Dx, wounds, dyspnea, pain…
– Functional
• Examples: Ambulation, transfers, bathing…)
– Services
• Examples: Estimated # of therapy visits
(PT/OT/SLP combined)
Home Health Data Sources
Report
Data Source
Key Factors
CASPER
OASIS
• Breadth of Process Measures & Outcomes
• Free
Home Health
Compare
OASIS & Claims
• Publicly reported risk-adjusted outcomes data
and HHCAHPS
• Free
HHQI
OASIS
• Depth of specific Process Measures & Outcomes
(ACH, OM, Influenza, PNE, Cardiac Risk Report)
• Comparative values to ALL CMS-reporting HHAs
• Free
Vendor
Vendor’s
participants'
OASIS
• Most are ‘real time’. HHA can create agencyspecific reports
• Fee
HHCAHPS
 CMS’s Consumer Assessment of Healthcare
Providers and Systems (CAHPS) for Home Health
 National standardized patient’s perceptions of
experience in home care
– Quality monitoring
– Hospices are now collecting CAHPS data
 Focus is on:
– Patient care
– Communication between providers and patients
– Specific care issues (e.g., medications, home safety,
and pain)
Why HHCAHPS Should Be
Important to HHAs?
 Referrals
– Customer focused
– Home Health Compare allows community
comparisons
– HHAs leverage their scores for marketing
 Value Based Purchasing coming
– CAHPS scores may be part of the criteria (not
known)
Other HHA Culture Concerns
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Face-2-Face
Therapy Reassessment
Fraud
Free-standing vs. System-based
Non-profit vs. For-profit
Certificate of Need States
Mergers & Acquisitions/Closures
Additional HHA Culture Concerns
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Siloes of Health Care
Staffing issues, including QI staff
Rural & Urban
Weather
Conditions of Participation (CoP)
 Proposed rule out for comment
 Overarching goals include:
– Focusing on assuring the protection and
promotion of patient right
– Enhancing the process for care planning, delivery,
and coordination of services
– Streamlining regulatory requirements
– Building a foundation for ongoing, data-driven,
agency-wide quality improvement
Value to the QIN-QIO
Program & 11th SoW
Cross–Setting Connections
 National Million Hearts® Initiative
– Hospitals, physician practices, community…
 Alignment with the ABCS and Physician PQRS
Measures
 Accountable Care Organizations (ACOs)
 Community-based Care Transitions Program
(CCTP)
11th SoW Task B.1 & Home Health
Focus on the ABCS
 Patient & Family Engagement
 Patient self-management &
prevention
HHA Recruitment
 Propose per Tasks B.1.2 & B.1.2.1
by January 31, 2015
 Include agencies willing to report
through the HHQI Cardiovascular
 Encourage BP assessment explicitly
Data Registry (HHQICDR) & use
the Best Practice Interventions
 Partner and stakeholder
Packages (BPIPs)
collaboration as appropriate
 Technical assistance via the BPIPs,
webinars, other means
 Learning and Action Networks
 Emphasize use of free resources
 Intentional targeting of agencies
serving African Americans,
Hispanics, and others as available
 Rural, profit, non-profit as
available
www.HomeHealthQuality.org
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HHQI
Special Project funded by
Centers for Medicare & Medicaid Services
Initial campaign 2007 and currently in 4th Phase
Goal: Improve the quality of care home health
patients receive through a cross-setting approach
Free tools, resources & networking
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The Home Health Quality Improvement (HHQI)
National Campaign
 Home health and cross-setting resources
 Four categories:
– Education
– Data
– Networking
– Assistance
Cardiovascular Care in the Home
Education Audience
Education Formats
 Primary BPIPs
– Larger more comprehensive
 Focused BPIPs
– Shorter with key resources and tools
 Video BPIPs
– New and coming Spring 2015
 Online education courses
– On-demand through HHQI University
HHQI Cardiovascular Resources
Multimedia Tools
3-minute video by Mayo Clinic
AHA’s series of animated pictures with
text on 15 different cardiac topics
Blood Pressure Assessment
 Accurate Blood
Pressure Monitoring
– Steps for accuracy
– Video and article from
New England Journal of
Medicine
– Blood Pressure Accuracy & Accurately Assessing
Orthostatic Hypotension
Patient Engagement
Smoking Cessation:
AHA 5-step Process
Set a QUIT
Date & sign a
no-smoking
contract
Choose a
method for
quitting
Make a plan for
your QUIT Day
Decide if using
medication
might help
Stop smoking on
your QUIT Day
AHA, 2011
Bulletin Board Templates
HHQI University
 Platform for learning with HHQI
– Monthly educational opportunities beginning
early 2015
– Individuals will register and have access to an
evolving catalog of educational
topics and opportunities
• Easy to use
• Focus on applying best practices
for improving patient outcomes
– Engaging clinicians
– Free Nursing CEs with many activities
UP Best Practice Intervention Package
Health
Disparities
DualEligible
Small
HHA
Underserved
Areas
HHQI Data Access System
HHQI Data Reports
Home Health
Cardiovascular
Data Registry
HHCDR Details
 Access HHCDR through normal Data Access
portal
 Each month, HHA will select which measures
(A, B, C and/or S)
 Patient demographic information will be
prepopulated on the 15th of every month
 All data ‘closed’ by the 14th of the month will
be used to create HHCDR Report to be posted
~23rd of the month
ABCS Data
ASPIRIN
Was the patient
taking ASA or other
antithrombotic?
CHOLESTEROL
Did the patient have a
lipid screening in the
past year? LDL-C?
BLOOD PRESSURE
SMOKING
What was the patient’s
final BP & was HTN
addressed?
Was the patient screened for
tobacco use? If a user, was an
intervention implemented?
HHCDR Chart Abstraction Tool
Sharing
of
HHQI
CardeioLAN
cardiovascular
Networking
knowledge &
application of resources
CardioLAN
Identifying
opportunities for
improvement
Direct access to the
HHQI Team
Cardio Milestones
 Join the Progressive Cardiovascular Learning & Action
Network (CardioLAN)
 Download all Cardiovascular Best Practice Intervention
Packages (BPIPs)
 Complete HHQI Data Access registration
 Close one month of required patients’ data in the Home Health
Cardiovascular Data Registry (HHCDR)
 Download one HHCDR report
 Enter patient data & close a total of six months of required
patients’ data for HHCDR
 Validate data
 Achieve noted improvement in one or more cardiovascular
outcomes
Network Coordinators
Anyone with routine communications with HHAs
& willing to assume a leadership role in guiding
the HHAs through the QI process:
 Professional Associations
 QIN-QIOs
 National Leaders
QIN-QIO Private Page
 2 people / QIN-QIO (not ‘per state’)
– Reports:
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Participant
Data / HHCDR Access
CardioLAN
Cardio Milestone Achievements (coming end of Dec.)
HHCDR Data (coming end of Dec.)
– Report Definitions
– Webinar tallies
 Post end of the month
 Data Access Plus
Accessing HHQI
Cardiovascular Learning & Action Network
Tips for Engaging HHAs
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Start with the HHAs basic QI needs
Allow them to set the pace
Align with current efforts
Be flexible with commitment & approaches
Co-brand as joint QIN-QIO & HHQI project
Additional Resources
 OASIS
– OASIS-C1
– OBQI CMS site
 Prospective Payment System (PPS)
– Final PPS Rule (11/06/14)
 Proposed Conditions of Participation
– Federal Register
– Proposed Rulemaking on Conditions of Participation for
Home Health Agencies: Revision of Requirements Fact
Sheet
– Talking Points with HHAs
Additional Resources
 HHQI
– Cardiovascular Health BPIP Part 1 (Aspirin/Blood Pressure)
– Cardiovascular Health BPIP Part 2 (Cholesterol/Smoking
Cessation)
– CoP Talking Points
– HHQI Data vs Home Health Compare
– Path Your Path 4-part Webinar Series (IHI and HHQI)
– Underserved Population Networking Event Archives
Questions?
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Next Steps
www.HomeHealthQuality.org
[email protected]
This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization supporting the
Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of
the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy.
Publication number 11SOW-WV-HH-MMD-111714