Industry Insights

The Home Health Compare results were updated on July 25, 2018.

For the Quality of Patient Care measures, 12 measures improved, 1 worsened, and 1 remained the same. As with last quarter, improvement in bed transfer saw the most improvement of 1.3%. Improvement in management of oral medications improved by 1.2%. Multifactor fall risk assessment conducted saw no change and Depression assessment conducted worsened by 0.1%. (Data Collection October 1, 2016 – September 30, 2017).

Acute care hospitalizations improved this quarter, from 15.9% to 15.8%, while Urgent, unplanned care in the emergency room remained at 12.9%. (Data Collection October 1, 2016 – September 30, 2017).

The national average for the Quality of Patient Care Star Rating remained at 3.5 stars. The percentage of agencies with 3 and 4.5 stars declined, and the percent of agencies with 2 and 5 stars increased.

HHCAHPS measures also updated and the national averages remain the same. The data collection period for these measures and the Star Ratings is January 1, 2017 – December 31, 2017.

To see where the 5 star agencies are located, visit our Home Health Compare page and use the drop down for Star Ratings at the agency level. You can also compare measures by state, by year, by release date, and the top 10 or top 20 percent.

The next generation of OASIS, OASIS-D, will go into effect on January 1, 2019. The changes are significant and could adversely impact publicly reported outcomes, Star ratings, value-based purchasing measures and reimbursement.

Learn How Fazzi Can Help Your Agency Prepare for OASIS-D
Potential Impact on Risk Adjustment
Some of the items being removed are used to calculate risk adjustment currently. We assume that CMS will need to take a fresh look at how risk adjustment is applied since these M-Items will no longer be available to use when calculating outcomes. There’s no way to correlate improvements or declines using the new OASIS items since the questions have never been on the OASIS before and statistical significance cannot be calculated. If risk adjustment isn’t revised, all the remaining OASIS responses used to calculate risk adjustment might now exert a greater percent of impact on outcomes. Therefore accurate OASIS responses are critical to ensure accurate outcome numbers.

Because of the items being removed, a patient could show less of a risk adjusted improvement. Therefore agencies could see a decline in risk adjustment in these areas:

Publicly Reported Outcomes Where Risk Adjustment May Be Lost	Star Ratings Where Risk Adjustment May Be Lost
Improvement in Pain (M1242) Improvement in Status of Surgical Wounds (M1342) Improvement in Dyspnea (M1400) Improvement in Bathing (M1830) Improvement in Bed Transfers (M1850) Improvement in Ambulation (M1860) Improvement in Oral Medication Management (M2020)	Improvement in Pain (M1242) Improvement in Dyspnea (M1400) Improvement in Bathing (M1830) Improvement in Bed Transfers (M1850) Improvement in Ambulation (M1860)

Areas of Potential Overlap, Duplication and Confusion
With the addition of the new GG functional items, there are several areas of potential overlap and duplication with existing M-Items. Because the items are similar but not the same, they are cause for confusion and therefore inaccuracy. For example:

Exsisting M-Items	Similar but Not the Same as These New GG Items
Ability to dress upper body (M1810) Ability to dress lower body (M1820) Bathing (M1830) Toileting hygiene (M1845) Feeding or eating (M1870)	Self-care (GG0130)
Toliet transferring (M1840) Transferring (M1850) Ambulation (M1860)	Mobility (GG0170)
Grooming (M1800)	Oral Hygiene (GG0130)

Dependent to Independent Sequencing Differences
Another area for potential confusion is the different scales for scoring patients. For the M-Items, Independent is captured in response ‘0’ but for the GG-Items, Independent is at the other end of the scale as response ‘06’.

In Conclusion
OASIS-D cannot be taken lightly or ignored until December. Planning now will protect outcome scores, Star ratings, and reimbursement. If you’d like information on how Fazzi can help your agency with the transition to OASIS-D, please click below.

Learn How Fazzi Can Help Your Agency Prepare for OASIS-D

CMS has posted the quarterly Hospice Compare refresh of quality data on May 16, 2018.

All quality measures showed improvement since last quarter posting! Pain assessment showed the most improvement, followed by pain screening.

Updates to the family caregivers’ survey results showed six measures remained the same. However, rating of this hospice and willing to recommend this hospice both improved by 1%. An improvement in these two global measures is an excellent, positive trend with these new caregiver survey results.

Quality measure results are from data collected 3rd quarter 2016 thru 2nd quarter 2017, and Hospice CAHPS® survey results reported 3rd quarter 2015 thru 2nd quarter 2017.

View State Level Hospice Compare Charts

CMS just proposed 435 ICD-10-CM code changes to be effective October 1. Here’s the breakdown: 247 new, 139 revised and 49 invalid codes. You’ll find the proposed changes in tables 6A, 6C, and 6E by clicking here.

It seems relentless, right? Coding changes in October… OASIS D in January… and with HHGM payment reform looming for 2020, coding and OASIS accuracy will be even more important to ensure correct reimbursement.

The constant need to train employees — in the face of mounting payment pressures and staffing challenges – is one of the reasons that so many agencies are turning to Fazzi for Outsourced Coding and OASIS Review services.

If you’re not outsourcing yet – or you’re not completely satisfied with your current vendor, now is the time to learn more about Fazzi’s Outsourced Coding and OASIS Review services. Click the link below to learn more or contact us at info@fazzi.com or 800-379-0361.

Learn More About Fazzi’s Outsourced Coding and OASIS Review Services

According to a national trend analysis by the Centers for Medicare & Medicaid Services (CMS), the average number of home health providers per county decreased by 7.31%, while hospice providers per county increased by 12.84% (October 2014 to March 2017).

The analysis and other utilization metrics can be viewed at the updated Market Saturation and Utilization Tool. These interactive maps include results at the national, state, or county level. The most recent data period is April 2016 to March 2017.

Sixteen health service areas are available for comparison including home health and hospice. The following metrics are available for comparison:

• Number of Fee-for-Service Beneficiaries
• Number of Providers
• Average Number of Users per Provider
• Percentage of Users out of FFS Beneficiaries
• Number of Users
• Average Number of Providers per County
• Total Payments

If you are interested in competitor data by agency or county level, click here to visit our web page on Business Intelligence or email info@fazzi.com.

The Home Health Compare results were updated on April 11, 2018.

For the Quality of Patient Care measures, 12 measures improved and 2 remained the same. No measures worsened. As with last quarter, improvement in bed transfer saw the most improvement of 1.3%. Improvement in management of oral medications and improvement in dyspnea both showed improvement of at least 1.0%. Multifactor fall risk assessment conducted and depression assessment conducted measures both saw no change. (Collection period July 1, 2016 to June 30, 2017.)

While the acute care hospitalizations measure improved again this quarter, from 16.2% to 15.9%, urgent, unplanned care in the emergency room continued to worsen with an increase of 0.1%. (Collection period July 1, 2016 to June 30, 2017.)

The national average for the Quality of Patient Care Star Rating remained at 3.5 stars. The percentage of agencies with 2.5 and 4 stars declined, and the percent of agencies with 4.5 and 5 stars increased.

Updates were also made for HHCAHPS measures and the national averages continue to remain the same. The data collection period for these measures and the Star Ratings is October 2016 to September 2017.

To see where the 5 star agencies are located, visit our Home Health Compare page and use the drop down for Star Ratings at the agency level. You can also compare measures by state, by year, by release date, and the top 10 or top 20 percent.

 

The Journey Has Begun!

Anita Werner, RN, BCHH-C, COQS, Senior Compliance Consultant at Fazzi Associates

Here’s what we know about OASIS-D so far:

• CMS has posted the new OASIS-D instrument and a supporting statement at this link.
• Comments are due May 11 which can be submitted via this link.
• CMS expects to issue draft guidance in July and final guidance in November.
• The revisions effective January 1, 2019 are intended to comply with the 2014 IMPACT Act.
• Changes to the assessment are extensive. CMS is removing 235 data elements across all OASIS items as a part of the Paperwork Reduction Act, however 6 new questions with multiple data items are added. For example, at Start of Care 75 data elements are removed, however 65 new elements are added.

Here are excerpts from CMS supporting statement:

• GG0130-Self Care, GG0170-Mobility, J1800-Falls Since SOC/ROC, and J1900-Number of Falls are included to meet IMPACT Act requirements for post-acute care settings to standardize assessment and reporting of (1) Falls with Major Injury, and (2) Functional Assessment of and Care Planning for Function.
• M1311 has been standardized across post-acute care settings to now be used to measure Changes in Skin Integrity: Pressure Ulcer/Injury with removal of M1313.
• GG0100-Prior Functioning and GG0110-Prior Device Use are added to standardize this data collection across post-acute care settings.
• Fifteen of the 28 OASIS questions removed provided risk adjustment for publicly reported outcomes. This means accuracy in the responses to remaining OASIS questions will be even more essential. Competence in OASIS-C2 will set the stage for success with OASIS D.

Fazzi is here to help you with these changes! Our OASIS Package available through The Fazzi Learning Center will automatically be updated with the changes and all Fazzi Learning Center customers will receive a free “crosswalk” training on the changes during the fall – not too early and not too late!. If you’re not already a Fazzi Learning Center customer and would like to learn more, please click here.

Stay tuned for additional updates on the journey to OASIS-D.

CMS has posted the initial publication of results from the CAHPS® Hospice Survey on Hospice Compare.  Results include all Medicare-certified hospices that had at least 30 completed surveys from April 1, 2015 to March 31, 2017.

Since the first release of national averages in December 2017 of the family caregivers’ survey results, treating patient with respect improved along with training family to care for patient, while willingness to recommend worsened (see table).

Updates to patient preferences and managing pain and treating symptoms saw improvement in five measures, with the most improvement in beliefs/values addressed and dyspnea treatment.  Dyspnea screening and patients treated with opioid who are given a bowel regimen remained the same while a slight improvement was seen in all other measures.

For state level Hospice Compare charts, click here.

National Averages for CAHPS® Hospice Survey Measures

Measure	National Average
	December 2017	February 2018
Hospice Team Communication	80%	80%
Getting Timely Care	78%	78%
Treating Patient with Respect	90%	91%
Getting Emotional and Religious Support	89%	89%
Getting Help for Symptoms	75%	75%
Getting Hospice Care Training	72%	75%
Rating of Hospice	80%	80%
Willingness to Recommend	85%	84%

Source: Medicare.gov, Hospice Compare. Data.Medicare.gov