For forward-thinking quality managers . . .
Preparing for the new outcomes climate
Here is advice from the experts on how quality managers can ensure that their home health agencies will be ready when changes in accreditation and reimbursement occur:
• Become familiar with the Outcomes Assessment and Information Set (OASIS).
This is the minimal data set HCFA will use in its prospective payment system for home health to ensure that providers are maintaining quality while they cut costs. (See related story, p. 30, and in Homecare Quality Management, February 1997, p. 13; June 1996, p. 61; and August 1996, p. 85.)
"While the OASIS system that HCFA implements may be somewhat different from its present form, it gives providers an idea of the kind of information they need to start collecting and analyzing to be ready for a PPS," says James C. Summerfelt, MS, PT, director of home health and rehabilitation planning operations for the Rehabilitation Institute of Chicago.
• Prevent outcomes collection problems with proactive QI.
Make sure all the systems by which you obtain outcomes-oriented information flow smoothly or eliminate barriers that would impede the progress of a quality improvement project, Summerfelt recommends. For instance, look at the process for taking referrals and make sure you get the information from referral sources so you can schedule your assessment as soon as the patient is discharged. Set an objective to have all patients assessed and admitted within 24 hours of referral and make sure your system can accomplish this. Make sure you have timely, accurate follow-up with referral sources.
• Make sure your system includes efficiency measures in your outcomes data.
This would include such measures as cost per visit and staff productivity, advises Alexis Wilson, MPH, RN, president of Outcomes Concept Systems in Gig Harbor, WA.
"In the future, agencies are going to have to show the value of their services through the outcomes that are achieved, as well as cost-effectiveness," she adds.
• Report data clearly.
Develop charts and graphs that provide a quick, concise overview of your organization’s capabilities.
Sipes reports that payers at a national managed home care conference said they want more sophisticated information from providers.
"When they look at 20 new contracts and proposals every week, they want something that stands out," Sipes says.
• Ferret out and eliminate duplication.
Set up a mechanism to track data that will ensure services aren’t being duplicated. For instance, when a patient is admitted to your home health agency, have a mechanism in place to make sure costly tests and evaluations completed in the hospital aren’t automatically repeated in a standard battery of tests, says Sipes.
• Make sure your outcomes data are timely and objective.
MCO payers aren’t interested in what your agency did five years ago, Murer says. Although payers are interested in how you stack up to national norms, they are more interested in what you can accomplish for them. This includes statistics on what outcomes you can expect to achieve, in what time frame, and for what costs, he adds.