Home Health & Hospice

Weekly roundup

Homecare Insider, February 29, 2016

Stars and confusion
CMS began publishing home health agency (HHA) Quality of Care star ratings, based on OASIS data and other information, on its Home Health Compare website last year. In January, it added Patient Survey star ratings, based on Home Health CAHPS surveys, to reflect the views of patients. The intent was to give physicians and patients an easy-to-use way to assess HHAs’ quality and choose the best one.

However, the patient satisfaction ratings and those for quality of care often don't match. In fact, 20% of agencies had clinical and patient ratings that differed by two stars or more, according to a recent Kaiser Health News analysis of government records. This might cause more confusion than confidence among consumers, according to a recent National Public Radio (NPR) report.

The discrepancy may be a result of how each rating is measured. The Kaiser research showed Medicare was more liberal in giving higher marks based on patients’ opinion scores, awarding four or five stars to 74% of agencies rated. Of those, 2,152 agencies got five stars. However, for clinical quality, Medicare used a different formula that ensured a majority of HHAs would receive three-star ratings. Only 27% of agencies received four or five stars. Just 286 agencies received the maximum five stars. Only 30 agencies got five stars from both ratings systems.

See the March issue of Homecare DIRECTION for an in-depth look at the Patient Survey star rating, how HHAs can boost their numbers, and what one double-five-star agency does to ensure continued success.

Source: NPR

NCQA seeks input for LTSS standards
The National Committee for Quality Assurance (NCQA) is now accepting public comments on its new accreditation program for Individuals Receiving Long-Term Services & Supports. The CM-LTSS accreditation is specifically geared toward organizations responsible for arranging LTSS. The CM-LTSS program will include standards from NCQA’s Case Management-Clinical Accreditation (formerly Case Management Accreditation) program, adpated for non-clinical programs, as well as new LTSS-specific requirements.

Effectively coordinating LTSS for individuals may reduce the need for acute medical care and prevent or delay nursing home placement, thereby reducing total costs, NCQA stated.

Reviewers are asked to submit comments via NCQA’s public comment website by March 23 at 5:00 p.m. Eastern Time.

Source: NCQA

Accessing home health isn’t easy for many rural Medicare clients
Rural communities, especially those served by small and non-profit home health agencies, face numerous obstacles and will likely benefit from payment reforms that reward quality services while providing incentives to use best practices in home healthcare, according to a report from the University of Washington School of Medicine WWAMI Rural Health Research Center.

The report identified potential solutions to some of these obstacles, including:

  • Legislation to allow nurse practitioners, physician assistants, and clinical nurse specialists to “prescribe” (order or certify) home healthcare.
  • Elimination of the face-to-face requirement, because of access issues involved in seeing a physician or non-physician practitioner who can complete the face-to-face visit and paperwork.
  • Some flexibility in the criteria for being “homebound.” Rural patients often won’t agree to the strict Medicare homebound requirement because they must travel to meet their basic needs. As a result, they are discharged without home health services and end up being readmitted to the hospital.

Source: WWAMI, Rural Health Research and Policy Centers

LeadingAge report advocates ‘rational’ LTSS insurance
A new system of financing LTSS must be insurance-based and guided by the principles of rationality, equity, and affordability because the current LTSS financing system is untenable, according to research conducted by Urban Institute and Milliman Inc. on behalf of LeadingAge, The SCAN Foundation, and AARP.

A universal insurance approach that covers catastrophic costs would have the greatest positive impact on both individuals and strained public programs, while creating a more rational system, according to the LeadingAge report. However, any LTSS insurance model:

  1. Must be self-sustaining and, if possible, relieve a strained Medicaid program.
  2. Must be affordable, easy to obtain, and available to all, regardless of pre-existing conditions.
  3. Is likely to incorporate the characteristics of a universal, public approach.

“Unless we find alternative approaches to LTSS financing, our ability to provide and pay for care for future generations of older Americans will be seriously impacted,” the report warns.

Source: LeadingAge