Reporting outcomes: QMs ‘called on the carpet’

5 tips prepare you for health plan demands

Home care patient satisfaction surveys will become more important to payers because home care agencies will be asked to quantify their value. But it no longer will be sufficient to report anonymous patient satisfaction results, home care executives warn.

"Home care is going to be held accountable," predicts Rose Bemis-Heys, RN, NP, vice president of business development for Matria Health Care in Santa Ana, CA. "Managed care is now asking, ‘I provided this home care. What did I get for my money?’"

Even if health plans don’t formally require home care providers to use the Health Plan Employer Data Information Set 3.0 (HEDIS 3.0) member satisfaction survey in addition to their own internal surveys, as some predict, you’re going to need to report patient satisfaction by:

• patient;

• payer;

• type of service;

• diagnosis.

"In six months, a quality manager is going to get a call from an HMO that is going to say, ‘How many of our breast cancer patients did you treat, and were they happy with your service?’" predicts Sandra E. Kretz, PhD, administrator of disease management and special projects at Quantum Olsten Health Services in Indianapolis.

If you can’t track their patients, they’ll find a home care company that can. "You may be providing wonderful care, but if you can’t track their patients and prove they’re satisfied, then you have no way of documenting that you are a provider whose services should be continued," she explains.

Here are five tips for collecting data that keeps your agency competitive:

1. Develop a system for tracking payer-specific patient satisfaction.

You can work with the information systems department to create an automated intake form that captures information needed to tie to satisfaction surveys later. Or you can develop a system for coding by hand. But either way, it’s your responsibility.

"The quality manager is going to be the person called on the carpet, but the IS department is going to have to ensure that your intake for the patient collects the data that enables you to later identify the patient, the payer, the type of service provided, and probably some kind of diagnosis code," says Kretz.

It’s more than just adding a box on the intake form, she warns. The clinical staff and quality management are going to have to have "real input" into IS services so that the form collects the information needed to find patients in the system and use their information for your own internal QI, as well as to report it to the health plan.

Quantum recently implemented a bar-coding system for tracking patient satisfaction surveys on a payer-specific basis. Previously, all coding was done manually. "You can only do so much by hand," Kretz advises.

2. Educate intake staff.

The quality manager will have to ensure that all intake staff are trained to code correctly. "If you don’t have people who know how to use that and fill it out properly, you’re going to get garbage data," Kretz says.

3. Consider adapting HEDIS member satisfaction surveys for home care use.

One way to collect patient satisfaction data that health plans can use is to alter the HEDIS membership satisfaction survey they are required to use so it yields home care-specific information, says Bemis-Heys.

"I’d take what HEDIS has done and apply it to the population I’d be dealing with," she advises. "I’d add some questions of my own to talk about my service, but you’ll probably want to hit the high points of HEDIS because it’s a pretty simple questionnaire."

Most of the questions are generic, but can be tailored specifically to home care. For example, HEDIS requires health plans to survey patients about their satisfaction with their "breast cancer treatment," says Kretz. "‘Were you satisfied with your treatment?’ doesn’t apply to home care, except that some home health agencies do treat breast cancer patients through home chemotherapy and pain management. So home care may be a part of that ‘treatment.’"

4. Read and understand HEDIS.

The best thing a quality manager can do is to read and understand HEDIS, and make sure executives at the agency do as well, even if your agency doesn’t collect HEDIS data, Bemis-Heys advises. Don’t ignore it just because most of the measures don’t seem directly applicable to home care. "They might expect this of the home care agency of the future," she says.

Kretz agrees. "You have to read the tea leaves. It’s hard to get a company to spend the money to do something when you’re not sure it’s a requirement."

5. Join the HEDIS Users Group.

HEDIS is a constantly evolving set of performance measures. Quality managers need to help mold HEDIS from a home care perspective "because it really is going to impact you," Bemis-Heys says. "If you can help to shape it for the future, that’s important."

[Editor’s note: A copy of the four-volume set of HEDIS 3.0 may be ordered from NCQA for $375. Volume 1 contains a narrative: "What’s in it and why it matters" ($125); Volume 2 contains the technical specifications for collecting and submitting HEDIS data ($200); Volume 3 contains the member satisfaction survey ($75); Volume 4 contains a road map for information systems that support performance measurement ($75). Telephone: (800) 839-6487. For information about joining the HEDIS Users Group, call Sandra Mizell at (202) 955-5199.]