Home Health Compare revisions planned for 2005

Beginning in Fall 2005, three new quality measures will be included in Home Health Compare, the system developed by the Centers for Medicare & Medicaid Services (CMS) that enables the public to compare a home health agency’s performance in specific areas to another agency’s performance.

The new quality measures include improvement in dyspnea, urinary incontinence, and discharge to the community. CMS also plans to add improvement in surgical wounds to the list of quality measures in fall 2005.

CMS plans to delete four current quality measures: improvement in upper-body dressing, stabilization in bathing, improvement in toileting, and improvement in confusion frequency.

The current quality measures that will remain in the Home Health Compare system are improvement in: ambulation/locomotion, bathing, transferring, management of oral medications, pain interfering with activity, acute-care hospitalization, and emergent care.

MedPAC recommends no update for HHAs

As expected, the Medicare Payment Advisory Commission (MedPAC) March Report to Congress recommended no market update for 2006 home health reimbursement.

MedPAC also recommended research on the home health prospective payment system (PPS) reimbursement to determine whether adjustments should be made to the case-mix system to ensure access to care for high-cost beneficiaries.

The report alluded to the possibility of replacing home health PPS, though it does not recommend another system to take its place. Also, it raises the possibility of two payment systems for Medicare home health, one for post-hospital patients and another for those who are chronically ill and require long-term care.

To support its recommendation of no market update for home health agencies next year, MedPAC argued that access to home health care is good, the number of HHAs is growing, home health growth is robust, quality has improved, the number of visits per episode is down, and PPS payments exceed costs by a wide margin — 12.1% in 2005.

The American Association for Homecare (AAHomecare) disputes MedPAC’s singling out home health, along with skilled nursing facilities, to receive no inflation update in 2006.

However, AAHomecare supports ongoing research to improve the PPS case-mix system to ensure access for all eligible beneficiaries.

AAHomecare will continue to work with MedPAC staff and commissioners, as well as Congress, to stress the value of home health care to Medicare and the need for adequate reimbursement so that home health agencies can continue to provide services to all eligible beneficiaries, including medically complex, long-term patients.

MedPAC endorsed implementation of a pay-for-performance system that provides higher payments for home health agencies, hospitals, and physicians who provide better care, as indicated in their outcome measures.

MedPAC notes that home health has Outcome-Based Quality Improvement outcome measures and Outcome-Based Quality Management adverse-event outcomes, with the latter not being appropriate to base a pay-for-performance system on — pending further development.

Quality measures used for pay-for-performance purposes should include more than outcome measures, incorporating also process measures, structural measures, patient satisfaction surveys, and transitional measures, such as those that transcend a single care setting.

AAHomecare’s pay-for-performance task force is developing a model pay-for-performance proposal to take to MedPAC, CMS, and Congress. The group is considering adding measures that fit into these last four categories.

MedPAC ties adoption of information technology (IT), which is a major goal of the Bush Administration, to the pay-for-performance concept. In addition to use of IT as a structural outcome measure to encourage adoption of technology, other options to encourage implementation of IT include grants and loans to providers, as well as simply mandating IT adoption as a condition of participation and payment in the Medicare program.

To obtain a copy of the 245-page MedPAC report, e-mail Ann Howard at AAHomecare: ahoward@aahomecare.org.

OCR addresses HIPAA privacy question

The Office for Civil Rights (OCR) posts answers to frequently asked questions related to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule on its web site: www.hhs.gov/ocr/hipaa/.

A recently addition to the FAQ section is a question about sharing protected health information (PHI) with an interpreter. According to OCR, patient authorization is not needed to disclose PHI to an interpreter when:

  • the interpreter is part of the provider work force;
  • the covered entity engages the services of the interpreter as a business associate;
  • the interpreter is a family member, close friend, or other person designated by the patient as the interpreter for a particular health care encounter.