Reevaluating the Current Star Rating System in Home Health
Most home health providers are well aware that quality reporting measures will be required to be submitted starting January 1, 2017 as part of the Medicare Post-Acute Care Transformation Act (IMPACT). Previously performance quality has been a fragmented process using a variety of reporting methods which themselves have varying scoring methodologies making it difficult for patients to compare care providers. In preparation of the IMPACT Act, a panel of home health professionals reviewed the current star rating system and recommended changes that align with value-based care guidelines and standardize scoring and reporting.
Aligning End Goals
The panel recognized a trend of insurers to favor caring for patients whose conditions are easier to treat under fee-for-service models. These types of cases are less complicated for home health providers as the cases have a measurable end goal with predictable care processes that allow providers to easily assign care team members and estimate associated cost. The short-term relationship also limits the time which the patient has to assess the care quality of the provider. This provides advantages for the organization to gain improved survey results. The care provider ultimately resolves the patient’s health issue, returning the patient to their previous quality of life, and likely earning high marks for care quality. The limited time needed for case management gives the care provider an “end date” which they can keep in mind when working with more difficult patients, knowing that they only have to be pleasant to the patient for a set amount of time instead of treating them for an open-ended period that might require them to address the difficulties or lose their patience with the patient all together.
These easier to treat conditions are in direct opposition to value-based purchasing goals which have been rewarding primary care providers who actively seek to treat patients with long-term, costly chronic conditions. As the population ages and healthcare advances, patients are living with these chronic conditions much longer, putting an increased burden on healthcare resources. Providers are anxious to work with these patients to meet value-based population health goals to manage chronic conditions and improve the long-term quality of life. Chronic conditions do not have a set time frame as the currently favored home health cases do. Home health providers and patients managing chronic care conditions need to establish a good working relationship for optimal outcomes including high scoring survey results. Patients who find managing their condition easy to do with their provider but see their home health provider challenging the recommended treatment are likely to communicate their frustrations in surveys. Industry experts strongly encourage home health agencies to align with the value-based goals to maximize patient engagement. As home health agencies can be seen to be extensions of their provider’s care, home health organizations should strive to be seen a partner supporting the primary care goals put forth by the primary care provider.
Standardization for Better Comparison
The disconnect between preferred case management is symptomatic of a larger problem in home health reporting. While home health providers have been looking for easy-to-resolve cases which receive quick reimbursement under fee-for-service, the measures of care are different than those for long-term maintenance of value-based favored chronic conditions. A patient who is recovering from knee surgery or dementia needs to be monitored for fall risk while a patient managing COPD will not. However, the COPD patient’s oxygen saturation levels and lung capacity will need to be measured whereas the previous patient cases would not. As such, a one-size-fits-all survey makes it difficult to compare the quality of care across the patient population.
The panel acknowledged that measures addressing the patient’s ability to be returned to the community do not favor long-term maintenance that is the focus of population health and more realistic for the current and future patient population while functional measures are better used to assess long-term quality of life for chronic condition management. As performance is publicly reported to Home Health Compare, it is important that patients behaving as consumers in the healthcare market are able to compare the scoring of similar types of care for their needs. The panel recommends reporting of measures which indicate both performance towards patient’s return to the community or managing chronic care needs based on evidence-based processes of care.
How to Address All Measures
Considering the duality of care needs among home health patients, it is wise for home health providers to assess their care team to identify members who are well suited for long-term healthcare relationships and those who are better suited for meeting short-term care needs, if they are not already. Management of the diverse needs of the patient population will help home health agencies ensure best coverage of care needs and improve care performance survey results.
Despite the type of care each member of your care team is suited for, make sure all your staff is knowledgeable of all processes to meet the needs of all patients in you serve. The IMPACT Act is a good reason to bring your team up to speed on care processes and address performance measures. Continued education on regulatory changes and evidence-based care will empower your team to provide the care your agency needs at all levels.
Meeting the Needs
Change is difficult. Implementing changes in a home health organization is even more difficult. Home health agencies who have chosen to measure performance using surveys have found one they are comfortable with and stayed with it. IMPACT will require a change in the survey process for everyone to allow for the most accurate reporting of standardized measures and make understanding the differences between the care agencies provide easier for patients.
While the change from fee-for-service to value-based purchasing is favoring long term care, the increase in outpatient procedures and reduced hospital stays will continue the need for short-term care with an end goal of returning the patient to the community. It is important that home health agencies meet the needs of both sides of the patient spectrum. The ability to demonstrate quality of performance of an agency will show in public reports both online and through word-of-mouth. The standardized measures that the IMPACT Act seeks to implement give you the chance to stand out for your commitment to both sides of population by meeting the needs of all patients.