by Lori Marmon PT, MBA, COS-C
Why the Home Health Quality Reporting Program Matters to Home Health Providers
The Centers for Medicare & Medicaid Services (CMS) manages quality programs that address many different areas of health care. These programs encourage improvement of quality through payment incentives, payment reductions, and reporting information on health care quality on government websites.
The Home Health Quality Reporting Program, or HHQRP, requires Medicare-certified home health agencies to collect and transmit Outcome and Assessment Information Set (OASIS) data for all adult patients whose care is reimbursed by Medicare and Medicaid. The OASIS data are used for multiple purposes, including calculating several types of measures and quality reports, which are provided to home health agencies to help guide quality and performance improvement efforts.
The HHQRP is part of CMS’ Quality Strategy focused on the improvement of health care delivery.
This CMS strategy includes goals related to helping patients and their families be involved as partners in their care, promoting effective prevention and treatment of chronic disease and preventing or minimizing harm in all settings.
The priority of the CMS strategy is to improve the delivery of health care as evidenced by the fact that participation in the HHQRP is mandated for home health agencies (HHAs) through the Social Security Act. Quality information from Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Home Health Care Survey data (HHCAHPS Survey) and Outcome and Assessment Information Set (OASIS) data is required to be submitted by home health agencies or agencies face a reduction in their annual payment update (APU) by 2%.
This is known as the “pay-for-reporting” requirement and demonstrates to agencies the critical nature of understanding and complying with the HHQRP requirements. HHAs who fail to reach the 90% threshold for the OASIS submissions or do not comply with the CAHPS® survey requirements will receive notification from CMS via an HH QRP non – compliance letter in late September-early October.
Beyond the submission of data being required by CMS, there are other uses and values to this data gathered for the HHQRP.
For example, the HHQRP uses data (from the OASIS) for a variety of purposes to support the CMS overarching strategy of improving the delivery of health care. One purpose is that the HHQRP calculates agency specific quality measures and delivers them in the form of quality reports to HHAs.
These reports can serve as guides for the agencies to drive and develop their individual quality improvement efforts based on data or information that is uniquely theirs. With this effort, the HHQRP is equipping each individual HHA with information that can allow and support individual agency contribution to the overall goal of improving the delivery of health care.
Perhaps the more well-known use for the HHQRP is the reporting of agencies’ star ratings. These publicly reported ratings are a means to indicate how well agencies are assisting their patients in their recovery and how well agencies are following best practices for care.
The use of a “star rating” system is designed to provide more user-friendly information to the general public when seeking out a care provider.
These ratings are posted on the site built by CMS, Care Compare, as a platform for a convenient source of information about provider quality. CMS has established 2 separate star rating systems for home health. Both are reported on the Care Compare website:
- Quality of Patient Care Star Ratings – calculated using select OASIS-based and claims-based quality measures.
- Patient Survey Star Rating – based on the patient experience of care measures gathered from the HHCAHPS survey.
For HHAs to best align their daily policies and procedures, it helps to have at least a rudimentary understanding of the HHQRP and the “why” behind some of the process and practices of an agency.
In order to reflect the good work going into patient care each day, agencies want to make sure this is appropriately captured through their care planning, OASIS accuracy and patient/caregiver satisfaction. CMS offers the training Achieving a Full APU/Market Basket Increase webinar.
Investing some time on understanding the HHQRP on a regular basis within your organization, may reap dividends in awareness, knowledge and investment in moving the HHA in a positive direction within the Home Health Quality Reporting Program.
Stay up to date on new CMS information related to HHVBP and OASIS accuracy.