What is a “Home Health Stay” in Claims-Based Quality Measures

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

A Home Health Stay is a term used as a unit of measurement in the claims-based utilization measures used in the Home Health Quality Reporting Program (HHQRP). The claims-based measures are calculated using Medicare fee-for-service (FFS) claims. Unlike OASIS quality measures that are calculated using OASIS data and are based upon the OASIS timepoints (i.e., start of care, resumption of care, transfer, discharge, death at home), the home health claims-based measures are calculated based upon the patient’s home health stay.

But what is a home health stay? Essentially, a stay is the period of time (based on the patient’s home health claim) used to calculate the measure. Of note is that the definition of a home health stay is not the same for all home health claims-based measures.

At first, this may seem confusing. But upon closer investigation, having a “stay” definition that best fits the quality measure is necessary to most accurately measure the quality of care intended to be represented by that measure.

In other words, having different definitions of a home health stay may be confusing, but the tradeoff is that the stay definition then supports a better measure of quality of care.

The table below provides a reference for these measures and how a stay is calculated.

Home Health Claims-Based Utilization Measures: Stay Definitions 

    # Measure Title Description of the Quality Measure Home Health Stay Description for the Quality Measure 
1 Acute Care Hospitalization During the First 60 Days of Home Health (HH) 

(ACH) 

Percentage of HH Stays in which Medicare FFS patients were admitted to an acute care hospital for an unplanned admission during the 60 days following the start of the HH Stay.     A HH stay is a sequence of home health payment episodes separated from other home health payment episodes by at least 60 days. 
2 Emergency Department Use without Hospitalization During the First 60 Days of HH  

(ED Use) 

Percentage of HH Stays in which Medicare FFS patients used the emergency department but were not admitted to the hospital during the 60 days following the start of the HH Stay.   
3 Discharge to Community  

Post-Acute Care (DTC) 

 

Percentage of HH Stays in which patients were discharged to the community and do not have an unplanned admission to an acute care hospital or LTCH in the 31 days and remain alive in the 31 days following discharge to community. HH Stay is a sequence of HH payment episodes separated by two (2) or fewer days.  A separation between HH payment episodes greater than two (2) days results in separate HH Stays. 

 

4 Home Health Within-Stay Potentially Preventable Hospitalization 

(PPH) 

Home health agency-level rate of risk-adjusted potentially preventable hospitalization (PPH) or potentially preventable observation stays (PPOBS) that occur within a HH Stay for all eligible stays. 
5 Potentially Preventable 30-Day Post-Discharge Readmission Measure  

(PPR) 

 

Percentage of HH Stays in which patients who had an acute inpatient discharge within the 30 days before the start of their HH Stay and were admitted to an ACH or LTCH for unplanned, potentially preventable readmissions in the 30-day window beginning 2 days after HH discharge. 

Of note is that the ACH and ED Use Measures will no longer be included in the HHQRP as of the October 2024 Refresh of Care Compare but will continue in the expanded HHVBP Model.

Claims-Based Measures included in the Expanded HHVBP Model

Through the CY 2024 Performance Year/CY 2026 Payment Year Beginning with the CY 2025 Performance Year/CY 2027 Payment Year 
  • Acute Care Hospitalization During the First 60 Days of Home Health (HH) (ACH)  
  • Discharge to Community-Post-Acute Care (DTC-PAC) 
  • Emergency Department Use without Hospitalization During the First 60 Days of HH (ED Use) 
  • Home Health Within-Stay Potentially Preventable Hospitalization (PPH) 
 ACH and ED Use measures will be removed from the Model measure set 

References

For additional information, visit the Downloads section on the HHQRP Quality Measures page of the CMS HHQRP webpage. Multiple measure resources are available, including:

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