Public Reporting


ElevatingHome members make an essential contribution to the Quadruple Aim in health care: better outcomes for patients and communities, smarter spending, better experiences for patients, and more satisfied practitioners. Home-based care organizations demonstrate their value to stakeholders by measuring and reporting on their performance. In this section we discuss measures that are public reporting in Home Health Compare, Hospice Compare, Star Ratings, and the IMPACT Act, illustrating how organizations can use the ElevatingHome Blueprint for Excellence to continuously improve performance.
 
The Blueprint for Excellence will help home-based care organizations to succeed in achieving the Quadruple Aim. Our content is also aligned with other key mandatory reporting frameworks, the IMPACT Act, and Home Health Compare. Crosswalks of Blueprint content to reporting requirements for home health and hospice can be found in Tables 1 and 2 below. 

Use these links to navigate to quality reporting sections
Home Health Measures          Hospice Measures

Use these links to identify quality improvement solutions for your agency:

 
Why Measure Performance and Evaluate Results in Home-Based Care?
Home-based care organizations will evaluate many aspects of care to assess their performance managing patients’ clinical conditions.  These may be cost, quality, experience, and outcomes. Measurement of serves multiple important purposes:
  • Quality Improvement: Measures should drive quality improvement goals and strategies. Agencies should consider monthly review of quality data and review of clinician-specific measures. Agencies with multiple branches should assess performance of each branch. These process and outcome measures can also be part of a Total Quality Assessment and Performance Improvement (QAPI) program.
  • Public Reporting: Public reporting offers insights to payers, patients, and the agency’s workforce about what type of quality and care is being delivered. It is imperative that agencies review all publicly reported measures in Home Health and Hospice Compare, along with Star Rating measures. Agencies should also anticipate and prepare for future measures reported for the IMPACT Act. Patient experience is particularly critical, as it is a factor in both word of mouth referrals and comparative ratings on Home Health and Hospice Compare.
  • Value-Based Purchasing: Value-based purchasing is becoming more prominent in home health and hospice care. The Blueprint’s module on Improving the Palliative Care Continuum illustrates how home-based care organizations can offer palliative care as a strategy to improve both value to payers, and patient experience. See VNAA's VBP e-Toolkit for information on how payers are linking reimbursement to outcomes and how agencies can prepare for the transformation.
ElevatingHome Best Practice Tip: Generate measurement reports weekly or at minimum, monthly highlighting current performance and performance goals. Review measurement reports with all team members, including clinicians. Secure team-members’ buy in on the importance of measuring and improving, and on the organization’s strategies for improvement. Develop criteria for improvement directly related to Home Health Compare and Star Ratings.
 
Drivers of Performance Measurement in Home Health
Home health agencies must use measurement and performance evaluation continuously to identify performance gaps and drive improvement. Home Health Compare and Medicare Star Ratings for Home Health make agency performance publicly available to patients, payers, and competitors. Home health Conditions of Participation require enhanced discharge planning and a patient centered care plan to improve quality and patient outcomes.
 
In addition, the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 requires home health agencies to report measures mandated by the IMPACT Act. IMPACT Act measures for home health are being phased in. Final specifications for 2017 new IMPACT Act measures are here. 
 
Table 1 illustrates how modules within the ElevatingHome Blueprint for Excellence crosswalk to requirements of Home Health Compare, Star Ratings, and the IMPACT Act. The Blueprint for Excellence recommends a systematic approach to measuring and improving performance that becomes a part of the agency culture.
Table 1: Cross Walk of Home-Base Care Reporting Requirements with the ElevatingHome Blueprint for Excellence
For Star Rating Category of: For IMPACT Act Measures of: Review Blueprint Modules on
Managing daily activities
 
Functional status, cognitive function, changes in function and cognitive function For All Patients: Maximizing function
Managing pain and treating symptoms   For All Patients: Control Pain
Treating wounds and preventing pressure sores Skin integrity and changes in skin integrity
 
Clinical Interventions: Pressure Ulcers
Preventing harm
 
Medication reconciliation
Incidence of major falls
For All Patients: Initiate Safe Care
For All Patients: Reconcile Medications
Preventing unplanned hospital care
 
Discharge to Community
Potentially preventable hospital readmission
For All Patients: Preventing Readmission and Promote Community Stay
Improving patient experience   For All Patients: Engage Patients/Enhance Experience
  Communicating the existence of and providing for the transfer of health information and care preferences For All Patients: Initiate Safe Care
Hospice Best Practices: Treatment Preferences
  Estimated Medicare Spending per Beneficiary VNAA’s Value Based Resources
All home-based care organizations are encouraged to review the module Build a High Performing Agency to identify best practices for delivering consistent high-quality care that contributes to the Quadruple Aim.
 
ElevatingHome Best Practice tip: Engage all staff in understanding and working towards performance goals. Generate measurement reports weekly or at minimum, monthly to be reviewed by team members, including clinicians. Develop criteria for improvement directly related to Home Health Compare and Star Ratings. To prioritize quality improvement efforts, analyze the data to determine which measures have the most impact on Star Ratings. For example, determine if performance on one measure may be impacting the organization’s overall Star Rating. A careful analysis can reveal ‘wins’, such that by improving just a little bit on a specific measure, the organization could be lifted into another Star Rating level. 
 
Critical Measures for Home Health
Home Health Compare: Home Health Compare is a patient-facing tool designed to support selection of a home-based care agency.  Home Health Compare consists of quality measures and survey measures. The quality measures are divided into four categories, and there is one survey category: Star Ratings: Medicare Star Ratings are made up of 9 measures plus a star for patient experience. Agency activities to that address major risk factors for hospitalization will drive improvements in many of the Star Ratings measures.
  1. Timely Initiation of Care
  2. Drug Education on all Medications Provided to Patient/Caregiver
  3. Influenza Immunization Received for Current Flu Season
  4. Improvement in Ambulation
  5. Improvement in Bed Transferring
  6. Improvement in Bathing
  7. Improvement in Pain Interfering With Activity
  8. Improvement in Shortness of Breath
  9. Acute Care Hospitalization
  10. Patient Experience reported in the Home Health CAHPS survey
IMPACT Act: The IMPACT Act mandates that standardized measures be reported by post-acute care providers in 8 areas. Many of the areas are similar to but not identical to measures in Home Care Compare and Star Ratings. Many measures are calculated by CMS using claims and OASIS data. IMPACT Act measures are being adopted on a rolling basis.
  1. Estimated Medicare Spending per Beneficiary
  2. Discharge to Community
  3. Potentially preventable hospital readmission
  4. Skin integrity and changes in skin integrity
  5. Medication reconciliation
  6. Incidence of major falls
  7. Communicating the existence of and providing for the transfer of health information and care preferences
  8. Functional status, cognitive function, changes in function and cognitive function
Additional Measures: Agencies may choose a variety of clinical measures and other indicators to assess their own impact on patient behaviors and specific disease states.  For example, agencies may use indicators of effectiveness in managing heart failure or COPD. In addition, agencies may want to evaluate effectiveness in teaching self-management skills, and ensure that the patient receives proactive interventions to prevent readmissions.  Agencies should carefully review data on readmissions and emergency visits to determine if patients with heart failure are over-represented. This is a signal that the home care agency needs to develop more effect strategies to support patients in remaining safely at home. 
 
VNANE Best Practice Tip: Tactics to enhance home care customer experience / satisfaction measures:
  • Provide staff education and training about patient experience, reports and influencers of satisfaction with recognition that there is a low margin of error for home care
  • Make telephone calls to each new patient 24 hours before start of care
  • Do a telephone check in with patient within the first 2 weeks of care to ensure satisfaction with quality of care
  • Post an agency-specific calendar posted in the patient’s home, on which the case manager writes the visit schedule for each discipline.
  • Have staff members make a telephone call before visiting
  • Adopt weekly and monthly measurement reports: team/clinician measures reviewed with supervisors “critical for improvement”
  •  Within the agency, spotlight positive stories for staff
Based on Press Ganey’s “The Banner Story: Improving Home Care Patient Satisfaction to Stay Ahead in a Competitive Market”

CMS Measures and Home Health Compare
 
Home Health Compare Website
CMS Measures Management Home Page
CMS Home Health Star Ratings Information
CMS 'Spotlight' Page with news and information on measures and reporting
Home Health CAHPS
CMS IMPACT Act website

Hospice Quality Measurement and Reporting
 
Hospice organizations currently report Hospice Item Set (HIS) measures and the Hospice Consumer Assessment of Healthcare Providers & Systems (CAHPS®) Survey of patient experiences. HIS and CAHPS are part of the national Hospice Quality Reporting Program, which requires the CMS to report quality measures on care provided by hospice programs across the country. Hospice public reporting through Hospice Comparebegan in 2017.
 
The Blueprint for Excellence is expressly designed to help hospices achieve high performance on hospice measures and reporting. Initiatives undertaken by home health and hospice organizations to improve care for patients, including helping patients to manage pain and maintain quality of life, improve results on both the HIS and Hospice CAHPS. 
 
Blueprint for Excellence modules align with the HIS and CAHPS, as shown in Table 2. In addition, ElevatingHome recognize that integration of home health and hospice, and offering palliative care as a step on the continuum, improves patient experience with the health care system. We recommend that organizations review the module on Developing the Palliative Care Continuum for best practices in developing integrated programs. By offering integrated, continuous care, home-based care organizations can improve patient quality of life, and patient care metrics.
 
The Hospice Item Set (HIS) requires 9 measures, including 8 that are endorsed by the National Quality Forum (NQF). Two measures added since inception calculate hospice visits when death is imminent, and performance on comprehensive admission assessment. Hospice CAHPS began in 2016 and is likely to be publicly reported in 2018.  HQRP measures may change over time. For current measures and detailed specifications, visit the CMS website, Hospice Quality Reporting Measures used for Hospice Compare:
  • Hospice and Palliative Care- Treatment Preferences - NQF #1641
  • Hospice and Palliative Care- Beliefs/Values Addressed- NQF #1647
  • Hospice and Palliative Care- Pain Screening- NQF #1634
  • Hospice and Palliative Care- Pain Assessment- NQF #1637
  • Hospice and Palliative Care- Dyspnea Screening- NQF #1639
  • Hospice and Palliative Care- Dyspnea Treatment- NQF #1638
  • Hospice and Palliative Care- Patients treated with opioids who are given a bowel regimen- NQF #1617 
  • Hospice Visits When Death is Imminent (No NQF Number)
  • NQF #3235 Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission (assesses the number of patient stays for which hospices met all of the NQF measures above)
  • The Consumer Assessment of Healthcare Providers & Systems (CAHPS®) Hospice survey information will be displayed in 2018.
 
Table 2: Crosswalk of HQRP and with ElevatingHome Blueprint for Excellence
Hospice Quality Reporting Measure Recommended Blueprint for Excellence Module
Treatment Preferences - NQF #1641 For All Patients: Engage Patients/Enhance Experience
Hospice Best Practices: Treatment Preferences
Beliefs/Values Addressed- NQF #1647 Hospice Care Initiation
Hospice Best Practices: Treatment Preferences
Pain Screening- NQF #1634
Pain Assessment- NQF #1637
Hospice Symptom Management
Hospice Care Initiation
For All Patients: Control Pain
Dyspnea Screening- NQF #1639
Dyspnea Treatment- NQF #1638
Hospice Symptom Management
Hospice Care Initiation
For All Patients: Control Pain
Patients treated with opioids who are given a bowel regimen- NQF #1617  Hospice Symptom Management
Hospice Care Initiation
Hospice Visits When Death is Imminent (No NQF Number) Hospice Symptom Management
Comprehensive Assessment at Admission - NQF #3235 Hospice Care Initiation
CAHPS® Hospice survey For All Patients: Engage Patients/Enhance Experience
Palliative Care Continuum
 
All home-based care organizations are encouraged to review the module Build a High Performing Agency to identify best practices for delivering consistent high-quality care that contributes to the Quadruple Aim.

New Measures and Private Sector Measures
CMS has also indicated an interest in developing measures relating to palliative care.  Some private sector organizations are also working on palliative care measures.  The California Health Care Foundation has developed a “Palliative Care Measures Menu” tool to assist organizations in identifying and using appropriate measures to evaluate effectiveness of care at the end of life.  The tool enables uses to input a variety of variables to select the most appropriate measures.  
 
The Illinois Homecare & Hospice Council (IHHC) developed a ‘massive open online course (MOOC)’ focusing on the role of palliative care in reducing hospital readmissions, and recommends a suite of measures the assess the impact of programs at the end of life.  These include:
 
Integration and Coordination
  • % Advance Care Planning Discussions
  • % Advance Directive Completion
  • %  Palliative care patients transitioned to Hospice
  • % Patients with documentation of pain management
  • Patient Satisfaction
Palliative Care Utilization
·         Readmission to Hospital
·         ED Visits
·         LOS in Hospital or Nursing Home
·         Cost Savings/Avoidance
 
Hospices are encouraged to monitor the CMS hospice quality measures website, as well as initiatives by organizations such as the National Quality Forum, to identify priority measures along the end of life continuum.  Along with CMS resources, required and emerging end of life measurement resources are listed below.
 
Required Reporting on End of Life Private Sector Quality Measurement Initiatives  
 
   
   
    Partner with referring clinicians and hospitals to develop programs and strategies to improve health outcomes and patient experience, and to help them meet accountability goals.  
   
    By effectively engaging patients and caregivers as partners in care, home-based care organizations improve experience, activation, and ultimately, outcomes.
Educate payers on opportunity to improve outcomes by more effectively caring for people in their homes. Drive smarter spending by preventing admissions and avoidable ED use.
Support clinicians and staff to practice in teams and at the top of their licenses, train for excellence, and recognize achievement.


Signature Events

Public Policy Leadership Series
  • October 3 - November 7
  • Wednesdays at 1pm ET
  • FREE for ElevatingHOME, VNAA and Alliance members

Virtual Events

 
Managing Tube Feeding Intolerance in the Home
  • October 18 | 1:00 p.m. ET
  • Sponsored by Nestle Health Science
Demystifying Home Health Risk Adjustments
  • November 6 | 3:00 p.m. ET
  • Sponsored by SHP

Partner Events

Submitting Your Medicare Part A Cost Report Electronically
  • October 15 | 1:30 p.m. ET
  • Hosted by CMS
Promoting Interoperability (PI) Workshop: Patient-Generated Health Data and Patient-Specific Education Measures
  • October 16 | 1:00 p.m. ET
  • Hosted by TMF Health Quality Institute