by Elaine Gardner, MS, RN, COS-C, CPHQ, CHPN
What do these three hospitalization measures tell you about your HHA’s patients and their experience?
Three home health hospitalization outcome measures in the HHQRP
The Home Health Quality Reporting Program (HHQRP) includes three outcome measures focused on the hospitalization of home health (HH) patients:
- Acute Care Hospitalization During the First 60 days of Home Health (ACH)
- Home Health Within-Stay Potentially Preventable Hospitalization (PPH)
- Potentially Preventable 30-Day Post-Discharge Readmission (PPR)
These three claims-based utilization measures use healthcare utilization data to indicate the health care experienced by home health patients and their unresolved care needs. As you review your HHA’s measure results, keep in mind that lower values are better than higher values because lower values show a lower rate of hospitalization among home health patients.
Medicare fee-for-service (FFS) claims provide the data for these three home health outcome quality measures. Furthermore, the home health stays for these measures are triggered based on the first home health claim for a Medicare FFS patient and ends either:
- After the first 60 days of the home health stay (ACH),
- Throughout the entire home health stay (PPH), OR
- During a period following home health discharge (PPR)
Now we see that each of these three measures includes a unique time period and will likely provide unique insights regarding the experience of your HHA’s Medicare FFS patients. Taking a deeper dive into each measure’s denominator, numerator, and outcome trends will provide valuable clues to refining quality improvement efforts and reducing the rate of hospitalization for your HH patients.
To assist you and your team, we have developed a side-by-side comparison table for these three HH hospitalization measures. Consider sharing this resource as your team reviews your HHA’s hospitalization measures and develops an action plan towards improvement!
A comparison of the three hospitalization quality measures in the HHQRP: ACH, PPH, and PPR
| ACH | PPH | PPR | |
| Measure Description | Percentage of home health stays in which patients were admitted to an acute care hospital during the 60 days following the start of the home health stay. | Home health agency-level rate of risk-adjusted potentially preventable hospitalization (PPH) or potentially preventable observation stays (PPOBS) that occur within a home health stay for all eligible stays. | Percentage of home health stays in which patients who had an acute inpatient discharge within the 30 days before the start of their home health stay and were admitted to an acute care hospital or LTCH for unplanned, potentially preventable readmissions in the 30-day window beginning two days after home health discharge. |
| Home Health Stay | A home health stay is a sequence of home health payment episodes separated from other home health payment episodes by at least 60 days. | A HH stay is a sequence of HH payment episodes separated by two or fewer days. A separation between HH payment episodes greater than two days results in separate HH stays. | A sequence of HH payment episodes separated by two or fewer days that begin during the 3-year observation period for patients who had an acute inpatient hospital discharge within the 30 days prior to the start of the HH stay and were discharged to the community from HH. A separation between HH payment episodes greater than two days results in separate HH stays. |
| Risk Adjusted | Yes | Yes | Yes |
| Uses |
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*For measure-specific exclusions, see the CMS Home Health Quality Measures – Outcome Table (in the downloads section at the bottom of the page).
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