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Quality Measures

Updates

July 25, 2017

Supplemental HH QRP materials described in the CY 2018 HH PPS Notice of Proposed Rule Making (NPRM) have been posted. The following documents can be found in the “Downloads” section:

  • Proposed Measure Specifications and Standardized Data Elements for the CY 2018 HH PPS Notice of Proposed Rule Making
  • OASIS 2019 Change Table for CY 2018 HH PPS NPRM
  • Proposed OASIS Items for CY 2018 HH PPS NPRM

July 25, 2017

Updated technical documentation for OASIS-based measures is now available in the downloads section. The specifications provide detailed information on using OASIS-C2 to calculate process, outcome and potentially-avoidable event (PAE) measures in the Home Health Quality Reporting Program and Home Health Quality Initiative, as well as patient characteristics and risk factors. The revisions to the Process and Potentially Avoidable Event documentation include edits made for clarity. The Patient Characteristics Transformations Documentation updates include specifications for low BMI, Peripheral Vascular Disease (PVD) or Peripheral Arterial Disease (PAD), diabetes and mobility status at start or resumption of care.

March 23, 2017

Updated Pressure Ulcer Measure Specifications Available

Revised measure specifications for the application of “Percent of Residents or Patients with Pressure Ulcers that are New or Worsened” (NQF #0678) are available in the “Downloads” section. The specifications have been updated to clarify the unit of analysis is home health quality episodes.

March 01, 2017

The Public Comment Summary Report for the Home Health Functional Status Process Measure is now available in the “Downloads” section below.  This cross-setting function quality measure is an application of the quality measure Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function (NQF #2631). This process measure reports the percent of patients with a start of care/resumption of care and a discharge functional assessment and a treatment goal that addresses function. The treatment goal provides evidence that a care plan with a goal has been established for the patient.

February 24, 2017

Revised technical documentation for the OASIS-based measures, as well as updated copies of the process, outcome and potentially-avoidable event (PAE) measures tables, are now available in the “Downloads” section below. Both sets of materials include technical clarifications to the information first posted in December 2016, to better reflect the January 1, 2017 implementation of OASIS-C2 and other program changes.

January 23, 2017

Updated Technical Documentation for the following claims-based home health measures is now available on the Quality Measures page.

  • Acute Care Hospitalization (ACH)
  • Emergency Department (ED) Use without Hospitalization
  • Rehospitalization during the First 30 Days of Home Health (Rehospitalization)
  • ED Use without Hospital Readmission During the First 30 Days of Home Health (ED Use without Hospital Readmission)
  • The updates accommodate ICD-10 changes.

December 22, 2016

Technical Documentation for the OASIS-based measures, updated to reflect the January 1, 2017 implementation of OASIS-C2, is now available. The specifications provide detailed information on the modifications for using OASIS-C2 to calculate process, outcome and potentially-avoidable event measures in the Home Health Quality Reporting Program and Home Health Quality Initiative, as well as patient characteristics and risk factors.

October 31, 2016

Specifications for the measures finalized in the HH QRP through the CY 2017 HH PPS Final Rule are now available. The specifications provide detailed information on the following proposed measures:

  • Discharge to Community-Post Acute Care Home Health Quality Reporting Program,
  • Potentially Preventable 30-Day Post Discharge Readmission Measure for Home Health Quality Reporting Program, and
  • Drug Regimen Review Conducted with Follow-Up for Identified Issues-Post Acute Care Home Health Quality Reporting Program.
  • Cross-Setting Pressure Ulcer Measure: Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (revision to fix a typo in the calculation algorithm).

The OASIS Item Set specifications for the measures finalized in the CY 2017 CY HH PPS Final Rule are also available.

The specifications for the measures proposed can be found in the Downloads section.

June 27, 2016

Comprehensive Review of Home Health Quality Measures

In 2015 and 2016, CMS undertook a comprehensive review of home health quality measures, including convening a technical expert panel (TEP) to review analysis of measure performance and scientific basis. A summary of the analysis and the TEP’s feedback, as well as the measures to be removed from the Home Health Quality Initiative based on this review, as notified in the CY 2017 HH PPS Notice of Proposed Rule Making, are available in the Downloads section below.

Quality Measures Used in the Home Health Quality Reporting Program

The following two categories of quality measures are used in the Home Health Quality Reporting Program (HH QRP):

  1. Outcome measures; and
  2. Process measures.

This page contains brief descriptions of each measure type and how the data for that measure is calculated. The Downloads section below provides links to technical documentation, tables identifying which Home Health Quality Measures are risk-adjusted and reported publicly, and additional resources.

(NOTE:  Additional quality measures related to the home health setting are calculated using data obtained from the Home Health Consumer Assessment of Healthcare Providers and Systems (HH CAHPS®).  These quality measures are not part of the Home Health Quality Reporting Program and therefore are not addressed on this webpage.)

Outcome Measures 

Outcome measures assess the results of health care that are experienced by patients.  The data for the Home Health outcome measures are derived from 2 sources:  (1) data collected in the Outcome and Assessment Information Set (OASIS) submitted by home health agencies; and (2) data submitted in Medicare claims.

Measures based on OASIS data are calculated using a completed episode of care that begins with admission to a home health agency (or a resumption of care following an inpatient facility stay) and ends with discharge or transfer to inpatient facility.  Measures based on home health claims data are calculated based on the first home health claim that starts an episode of care for a patient and end either 30 or 60 days after the initial claim (see section titled Claims-Based Utilization Measures below).

All outcome measures used in the HH QRP are risk adjusted. The risk adjustment methodology, using a predictive model developed specifically for each measure, compensates for differences in the patient population served by different home health agencies. Clinical outcome measures for which the predictive models did not meet the criteria R2 > 0.10 or C-statistic > 0.70 are designated with a pound sign (#) in the Home Health Outcome Measures Table (located via the link for Home Health Measures Tables in the Downloads section below) to highlight the fact that they have less robust risk adjustment.

There are 3 types of Outcome measures used in the HH QRP:

  1. Improvement measures (i.e., measures describing a patient’s ability to get around, perform activities of daily living, and general health);
  2. Measures of potentially avoidable events (i.e., markers for potential problems in care), and
  3. Utilization of care measures (i.e., measures describing how often patients access other health care resources either while home health care is in progress or after home health care is completed).

For a list of outcome measures used in the HH QRP, please refer to the Home Health Outcome Measures Table, which can be located via the link for Home Health Measures Tables in the Downloads section below. Technical Specifications for calculating OASIS-based outcome measures, patient-related characteristics measures, and risk factor measures used to risk adjust outcome measures, using both OASIS-C1/ICD-9 and OASIS-C1/ICD-10, can be accessed via the link for Technical Documentation of OASIS-Based Measures in the Downloads section below. The Downloads section also has a link for the Outcome-Based Quality Improvement Manual which contains additional information about the outcome measures, including data source and calculation period.

Potentially Avoidable Event Measures

Potentially avoidable event measures are a subset of outcome measures used in the HH QRP.  Potentially avoidable events serve as markers for potential problems in care because of their negative nature and relatively low frequency.  The potentially avoidable events reported are outcome measures, in the sense that they represent a change in health status between start or resumption of care and discharge or transfer to inpatient facility. All the potentially avoidable event measures are adjusted for variation in patient characteristics.

For a list of the potentially avoidable event measures used in the HH QRP, please refer to the Home Health PAE Measures Table, which can be located via the link to the Home Health Measures Tables in the Downloads section below. The predictive model for Development of Urinary Tract Infection did not meet the risk-adjustment criteria of R2 > 0.10 or C-statistic > 0.70 and so is designated with a pound sign (#) in the table to highlight the fact it has less robust risk adjustment.

Technical documentation for calculating potentially avoidable event measures using both OASIS-C1/ICD-9 and OASIS-C1/ICD-10 can be accessed via the link to Technical Documentation of OASIS-Based Measures in the Downloads section below. The Downloads section also has a link for the Outcome-Based Quality Monitoring Manual which contains additional information about the potentially avoidable event measures.

Claims-Based Utilization Measures

Claims-based utilization measures are a subset of outcome measures used in the HH QRP. They are calculated based on the first home health claim that starts an episode of care for a patient and include negative events such as hospitalization or emergency department care within a certain time frame. They evaluate the rate of potential problems in care that are indicated by the utilization of specific services. Lower values are preferable to higher values because they indicate fewer negative events for patients at that home health agency.  

The following four claims-based utilization measures are currently used in the HH QRP:

    • Acute Care Hospitalization (ACH)
    • Emergency Department (ED) Use without Hospitalization
    • Rehospitalization during the First 30 Days of Home Health (Rehospitalization)
    • ED Use without Hospital Readmission During the First 30 Days of Home Health (ED Use without Hospital Readmission)

The “ACH” and “ED Use without Hospitalization” measures evaluate patient admission to an acute care hospital and emergency department (without hospitalization), respectively, during the 60 days following the start of home health stay.  They are risk-adjusted using a predictive model developed specifically for the measures which takes into account differences in patient health status, as measured by the patient’s previous Medicare claims. These measures were first included on CASPER reports in August 2012. Public reporting of these measures on Home Health Compare began in late 2012/early 2013.  Detailed current specifications for the “ACH” measure and “ED Use without Hospitalization” measure can be found in the Claims-Based ACH and ED Use Measures Technical Documentation and Risk Adjustment Model link below under Downloads.

The “Rehospitalization” and “ED Use without Hospital Readmission” measures evaluate readmission to the hospital and emergency department (without hospital readmission), respectively, within 30 days after starting home health care for patients who were recently discharged from an inpatient setting.  They are risk-adjusted using a predictive model that incorporates five categories of risk factors, including the patients' prior care setting, age and sex interactions, health status, Medicare enrollment status and other interaction terms (e.g., a patient with chronic heart failure and chronic obstructive pulmonary disease). These measures first were included on CASPER reports in January 2014. Public reporting of these measures on Home Health Compare is scheduled to begin in January 2015.  Detailed specifications for the “Rehospitalization” and “ED Use without Hospital Readmission” measures can be found in the Home Health Rehospitalization Measures Technical Documentation and Risk Adjustment Model link below under Downloads.

The “Rehospitalization” and “ED Use without Hospital Readmission” measures are harmonized with the “ACH” and “ED Use without Hospitalization” measures, respectively. For an explanation of how these measures sets are harmonized with each other, please refer to the technical report included with the Home Health Rehospitalization Measures Technical Documentation and Risk Adjustment Model link below under Downloads.

Process Measures

Process measures evaluate the rate of home health agency use of specific evidence-based processes of care. The HH QRP process measures focus on high-risk, high-volume, problem-prone areas for home health care. These include measures pertaining to all or most home care patients, such as timeliness of home care admission, immunizations, and use of risk assessment tools for falls, pain, depression, and pressure ulcer development. There are also measures for specific diagnoses (heart failure, diabetes, pressure ulcers) and measures of care planning and clinical interventions delivered for patients experiencing certain symptoms (pain, depression).

Process measures are derived from data collected in the Outcome and Assessment Information Set (OASIS) submitted by home health agencies and are calculated using a completed episode of care that begins with admission to a home health agency (or a resumption of care following an inpatient facility stay) and ends with discharge or transfer to inpatient facility.

Unlike the outcome measures, process measures are not risk adjusted. Risk adjustment is not considered to be necessary for process measures because the processes being measured are appropriate for all patients included in the denominator (patients for whom the measure is not appropriate are excluded).

For a list of process measures used in the HH QRP, please refer to the Home Health Process Measures Table, which can be located via the link to Home Health Measures Tables in the Downloads section below. Technical documentation for calculating process measures using both OASIS-C1/ICD-9 and OASIS-C1/ICD-10 can be accessed via the link to Technical Documentation of OASIS-Based Measures in the Downloads section below. The Downloads section also has a link for the Process-Based Quality Improvement Manual which contains additional information about the process measures.

Downloads