Transcript McGregor / VNA

HHCAHPS and
Cardiovascular Care
in the Home
Using Data to Improve
Patient Experience of Care
Rita Grimes, MSN, ICCST, HCS-D, BCHH-C, COS-C
Project Manager, Qualidigm
Objectives
• At the end of this session, each participant will
be able to:
– Describe the collection process of HHCAHPS
– Operationalize an HHCAHPS improvement plan
– Align specific areas of need with implementation of
preventative cardiovascular care
HHCAHPS Promotes Person-Centered Care
Safe
Person-Centered
Care
Timely
HHCAHPS
Equitable
Effective
Efficient
Patient Experience of Care
• HHS Transparency Initiative
• Uses the Home Health Consumer Assessment of
Healthcare Providers and Services (HHCAHPS) survey
– AARQ survey
– Endorsed by NQF
• Reporting requirement as of 2012
• 2% reduction in annual payment update reimbursement
rates for not complying
• Anticipated to factor into a performance-based
reimbursement system
HHCAHPS Survey
• 5 Measures
– 3 Composite
– 2 Global
• Adjusted for differences in case mix across
agencies
• English, Spanish, Chinese, Russian, and
Vietnamese
– https://homehealthcahps.org/
HHCAHPS Survey Vendor
• Medicare-certified HHAs
– Required to contract with an approved HHCAHPS
survey vendor
• https://homehealthcahps.org/GeneralInformation/Ap
provedSurveyVendors.aspx
– Vendors listed have had their Quality Assurance Plan (QAP)
accepted by Medicare or are currently under review
– All listed are qualified to administer the Home Health Care
CAHPS Survey and
• Have met the requirements for conducting the survey on behalf of
Medicare-certified home health agencies.
Reporting Requirements for 2015
Surveys Inclusion Period
• CY 2015 requirement
– Continued monthly HHCAHPS data collection and
reporting for 4 quarters.
• Data collection period for CY 2015 includes
– Second quarter 2013 through the first quarter 2014
(the months of April 2013 through March 2014).
Reporting Requirements for 2016
Surveys Inclusion Period
• CY 2016 requirement
– Continued monthly HHCAHPS data collection and
reporting for 4 quarters.
• Data collection period for the CY 2016
– Includes the second quarter 2014 through the first
quarter 2015 (the months of April 2014 through
March 2015).
Reporting Exemptions for 2016
• Not Medicare certified throughout the period
of April 1, 2013 through March 31, 2014
– These HHAs do not need to complete a HHCAHPS
Participation Exemption Request form for the CY
2016
Reporting Exemptions
• HHAs that had fewer than 60 HHCAHPS-eligible
unduplicated or unique patients in the period of April 1,
2013 through March 31, 2014
• Request an exemption from the HHCAHPS data
collection and submission requirements for the CY 2016
– Complete the CY 2016 HHCAHPS Participation Exemption
Request form.
– https://homehealthcahps.org
https://homehealthcahps.org/ForHHAs/ParticipationExemp
tionRequestForm.aspx
– This deadline for the exemption form is firm, as are all of
the quarterly data submission deadlines.
Vendor Assistance
• HHCAHPS survey vendors
• Provide continual feedback on particular questions
of the survey so that they are kept apprised of any
issues that their patients are reporting on the
HHCAHPS surveys
• Some vendors cross reference OASIS data to
composite measures
– e.g. “Specific Care Issues” talking about medications to
process OASIS items
Global Measure - Overall Rating of Care
• Patients who gave their home health agency a
rating of 9 or 10 on a scale from 0 (lowest) to
10 (highest)
• Question #20 of HHCAHPS
– National average 84%
– Data collection period April 2013  March 2014
Global Measure - Likelihood of
Recommending
• Patients who reported YES, they would
definitely recommend the home health agency
to friends and family
• Question #25 of HHCAHPS
– National average 79%
– Data collection period April 2013  March 2014
Composite Measure - Care of Patients
• Patients who reported that their home health
team gave care in a professional way
• Gave care in a “Professional way” means
–
–
–
–
No problems with the home health care
Providers were always gentle
Providers were always respectful
Providers were always up-to-date about the patient’s
treatment
• Questions #’s 9, 16, 19 and 24
– National average 88%
– Data Collection period April 2013  March 2014
Composite Measure - Communication
• Patients who reported that their home health team
communicated well with them
• “Communicated well” means that the home health
agency did all of the following
–
–
–
–
–
Explained services before giving them
Gave advice promptly
Always said when staff would arrive
Always explained things clearly
Always listened carefully
• Questions 2, 15, 17, 18, 22 and 23
– National average 85%
– Data collection period April 2013  March 2014
Composite Measure - Special Care Issues
• Patients who reported that their home health team
discussed medicines, pain, and home safety with
them
• Care team discussed
– Medicines
– Pain
– Getting around their home safely
• Questions 3, 4, 5, 10, 12, 13, 14
– National average 84%
– Data collection period April 2013  March 2014
Operational Approaches to Improve
Patient’s Experience of Care
• Designated Champion
• Procedures for check-in with the patient and
family
– Transitions or QI staff
• SMART goal imperative
Operational Approaches to Improve
Patient’s Experience of Care
• Effective communication depends on
– Provider confidence
– Patient engagement
•
•
•
•
Walk-about
Walk-with
Adopt engagement techniques
Develop patient and staff confidence
Outcome Approaches
Patient Experience of Care
• Routinely consider ratings in the context of
OASIS
– Are processes used to recognize medication issues
– Are processes used to teach about medications
– Do patient outcomes reflect improvement in
medication management
• When inconsistencies found
– Explore accuracy of OASIS ratings
– Assessment approaches
– Teaching techniques
Process Approaches to Improve
Patient Experience of Care
• Chronic Care Management and certification
• Work toward consistent messaging
– Within care team
– Across provider community
• IT and EMR applications
– Episode Management
– Predictive Modeling
– Best Practice Guides
Resources
• HHCAHPS Survey at
https://homehealthcahps.org.
Questions
R I TA L W G R I M E S
[email protected]
(860) 632-6334
HHCAHPS Connection to
Cardiovascular Health
 Six Domains of Measurement (1-3)
Clinical Care
Person/Caregiver
Centered Experience
& Outcomes
Safety
• Integrate CVH interventions and strategies
• Use action planning related to CVH
• Assist with managing blood pressure, cholesterol, and/or smoking
• Care about patient and their “heart”
• Utilize action planning and CVH tools or workbook
• Use teach-back, CVH games & activities
• Decrease cardiovascular risk
• Improve CV medication understanding and adherence, especially HTN
medications
• Reduce hospitalizations, emergent care, and falls
HHCAHPS Connection to
Cardiovascular Health
 Six Domains of Measurement (4-6)
Efficiency & Cost
Reduction
• Reduce hospitalizations and emergent visits
• Avoid extra physician visits
• Create team approach to CVH
Care Coordination
• See all disciplines taking vital signs (except where state law
prohibits)
• Reinforce CVH teaching and tools (all disciplines)
• Focus teaching around patient’s goal and strategies patient selects
Community &
Population Health
• Educate clinicians on race/ethnic CV disparities
• Utilize culture sensitive CV education
• Care about the patient and their culture
HHQI Resources
 Cardiovascular Health Part 1 (merged) BPIP
 Cardiovascular Health Part 2 (merged) BPIP
 Person-Centered Care
– My Action Plan
• English (2 versions)
• Spanish & Chinese
• Cardiovascular version
coming 02/02/15
HHQI Resources
 Person-Centered Care
– Patient Self-Management BPIP
• Motivational Interviewing
resources
• Putting it into Practice
Clinician Guide
• Skit on Self-Management
– Cross Settings I BPIP
• Nurse practice exercise &
teach-back cards
HHQI Resources
 Person-Centered Care
– Fundamentals of Reducing
Acute Care Hospitalizations
BPIP
• Zone Tools
– Spanish versions being
posted
– Emergency Care Plan
• Also available
in Spanish
HHQI Resources
 Team-Approach
– Patient Self-Management BPIP
• Patient Self-Hospitalization
Risk Assessment (3-pgs)
– Cardiovascular Health Part 2
BPIP
• Take Control of Your Cholesterol
(2-pg)
• My Questions about My Heart
for My Doctor
HHQI Resources
 Care Coordination
– Patient Self-Management BPIP
• Personal Health Records
– English & Spanish
– Cross Settings II BPIP
• Discharge Criteria
(2 versions)
HHQI Resources
 Community & Population Health
– Underserved Population BPIP
Health
Disparities
DuallyEligible
Small
HHA
Underserved
Areas
Questions?
31
Thank you!
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-121814