New Claims-based Measures for Hospitalization and ED Use

January 23, 2013

As reported in the Final Rule for CY 2013, there are significant changes in how the home health hospitalization rates are calculated. On January 17, 2013, the hospitalization measures based on these new calculations were posted on Home Health Compare.  Specifically, the Acute Care Hospitalization (ACH) and Emergency Department (ED) Use Without Hospitalization are now based on Medicare claims-based data rather than on OASIS-based data.

Key points to note:

  • Claims-based measure is based on the Start of Care (SOC) date instead of the transfer/discharge date.
  • Numerator:  the number of home health stays for patients who have a Medicare claim for an admission to an acute care hospital or for an emergency department visit in the 60 days following the start of the home health stay.
  • Exclusions from the Measure Numerator
    • Planned hospitalizations are excluded from the acute care hospitalization claims-based measure numerator.
  • Observation stays that begin in a hospital emergency department but do not result in an inpatient stay within the 60 days after the start of home health care are counted in the ED Use without Hospitalization measure.
  • Observation stays that result in an inpatient stay within the 60 days after the start of home health care are counted in the Acute Care Hospitalization measure even if the patient is discharged from the home health agency.
  • Denominator:  the number of home health stays that began during the reporting period.
  • Exclusions from the Measure Denominator
    •  Home health stays for patients who are not continuously enrolled in fee-for-service Medicare during the 60 days following the start of home health stay. (Medicare lacks full information about the patients utilization of health care services and cannot determine if care was sought in an ED during the numerator window,  60 days time period)
    • LUPAs are excluded from claims-based measure
    • Home health stays in which the patient receives service from multiple agencies during the first 60 days are excluded from the denominator.
    • Home health stays for patients who are not continuously enrolled in fee-for-service Medicare for six months prior to the start of the home health stay. (This is excluded because Medicare lacks information about the patient’s health status that is needed for risk adjustment)
  • There is significant difference in the claims-data and the OASIS-data for the ACH measures so they are not comparable. To continue to track your ACH rate by OASIS-based data, this data will continue to be reported on the CASPER Reporting System.

For Specifications for Home Health Claims-Based Utilization Measures, Click Here

Return to www.thinkhomecare.org


How does Massachusetts Compare to National Results from HHCAHPS?

April 25, 2012

Results from the CMS national survey, Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey, that asks patients about their experiences with Medicare-certified home health agencies, are now available on Quality Care Finder website.

Massachusetts scored better or the same compared to national results for 4 out of 5 survey items. “Percent of patients who reported that their home health team gave care in a professional way” was the survey result where Massachusetts scored 1% less than the national level. See how specific agencies in your local area compare to the state and national results.

HHCAHPS will be updated every four months with new survey data and will complement the clinical measures available on the “Home Health Compare” website. This survey collects feedback on topics that patients have identified as important to them in determining which home health agencies provide high-quality care. Ratings include an overall rating of home health care and a patient’s willingness to recommend the agency to someone else.

For more information on the survey, visit https://homehealthcahps.org.

Return to www.thinkhomecare.org.


HHCAHPS to be Posted on Home Health Compare Tomorrow

April 18, 2012

The Centers for Medicare & Medicaid Services (CMS) plans to begin publicly reporting results from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey on April 19, 2012. HHCAHPS Survey results will be reported for a Medicare-certified home health agency based on 12 months worth of HHCAHPS Survey data. These customer survey results will be posted on Home Health Compare.

The survey results will be refreshed each calendar quarter, with data from the oldest quarter being replaced by data from the most recent quarter of the HHCAHPS Survey.

Return to www.thinkhomecare.org.


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