Home Health Quality Measures: Risk Adjustment for Cognitive / Mood / Behavior

by Elaine Gardner, MS, RN, COS-C, CPHQ, CHPN

Why Risk Adjustment in Quality Measures?

Risk adjustment in home health (HH) quality measures occurs for the purposes of adjusting for patient characteristics that are present at start of care (SOC) or resumption of care (ROC) time points, to ensure the measures are adequately robust and allow for valid comparison across providers.

The OASIS-based HH outcome measures that are risk adjusted, use OASIS items that are statistically significant and clinically relevant predictors of the quality measure outcome to adjust the measure results based upon the patient characteristics applicable to that measure. Each risk-adjusted measure has its own unique risk model. Most OASIS-based outcome measures are risk adjusted.

This means that as your agency analyzes data and implements improvement efforts, consider analyzing your data and accuracy related to the OASIS assessment items used to risk adjust the outcome measures.

To support HH quality measures being reflective of quality of care provided by HHAs in the home setting, CMS periodically re-evaluates and implements changes to the OASIS data item set and the quality measure risk models. The most recent updates to the Risk Adjustment Technical Steps and Risk Factor Specifications were effective starting January 1, 2023, with updates then occurring in March 2024 related to the new Discharge Function Score quality measure The risk model updates effective January 1, 2023 were developed using OASIS national repository data from assessments submitted between January 1, 2021 and December 31, 2021.

All risk-adjusted outcome measures use one or more of the OASIS-E cognitive, mood, or behavior items in the measure’s risk model. OASIS assessment items in these three (3) sections include:

Section C. Cognitive Patterns

• C0100. Should Brief Interview for Mental Status (C0200-C0500) be Conducted?
• Brief Interview for Mental Status (BIMS) (C0200 – C0500):
  • C0200. Repetition of Three Words
  • C0300. Temporal Orientation (Orientation to year, month, and day)
  • C0400. Recall
  • C0500. BIMS Summary Score
  • C1310. Signs and Symptoms of Delirium (from CAMC)
  • M1700. Cognitive Functioning
  • M1710. When Confused
  • M1720. When Anxious

Section D. Mood

• D0150. Patient Mood Interview (PHQ2 to 9)
• D0160. Total Severity Score
• D0700. Social Isolation

Section E. Behavior

• M1740. Cognitive, Behavioral, and Psychiatric Symptoms
• M1745. Frequency of Disruptive Behavior Symptoms

The table below lists the risk-adjusted OASIS-based outcome measures and the OASIS cognitive, mood, and behavior assessment items used to risk adjust each measure. Note that C0100 – Should Brief Interview for Mental Status (C0200-C0500) be Conducted? and Brief Interview for Mental Status (BIMS) (C0200 – C0500) are not included in the current risk models as data collection for these items began January 1, 2023. CMS is planning to evaluate these items for possible inclusion in future risk models.

To support accurate coding of OASIS items and your agency’s outcomes, include staff training and monitoring on a regular basis for those OASIS items used in quality measure risk adjustment.

References

For additional information and resources, visit the Downloads section on the HHQRP Quality Measures page of the CMS HHQRP webpage and the Expanded HHVBP Model webpage.

Interested in further enhancing your OASIS accuracy? Consider joining the OASIS Answers Team at an upcoming Blueprint for OASIS Accuracy 2-day workshop.