Home Care Compare, have you seen it??

Specialties Home Health

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Specializes in Home Health.

This week, CMS (The Centers for Medicare and Medicaid Services, formerly known as HCFA) released a report card of all the home health agencies in NJ, possibly in the states, I am not sure if it is nationwide.

Anyway, this is the fruit of your labors in doing the OASIS. The MO questions on the OASIS are evaluated at admit to HH service and at discharge, to assess outcomes.

In our local newspaper, a huge one pafe ad was placed which listed almost all the agencies in NJ, and compared 3 outcomes; Patients who get better at bathing, Patients who get better at walking ro moving around, and Patients who get better at taking their medicines correctly (by mouth.)

I don't know how your agency handles the ADL questions, but notoriously, our nurses open the cases and score higher, while PT scores lower on their eval, and in the end. It is prbably the nurses who do not actually have the pt demoe getting in and out of the tub, and therefore we don't assess as accurately. I do make my pt's transfer from a sit to stand and walk a short distance to see how steady they are if nothing else. I make them walk to get their meds so I can evaluate this, if they are able of course.

As far as the meds go, do you really feel like those questions could ever show a positive outcome?? I mean if the pt had a CG pre-pouring their meds before admit, and this was safe and effective, naturally, this stays the same at discharge. So sure there won't be a difference? And that is perfectly safe and fine in my book, but since it would not show any improvement, it appears to the uneducated eye, that HH agencies are not improving people's abilities to take their meds. The ad did not print stats about injections or inhalers, which may have actually reflected great improvements in these areas as we teach new diabetics to inj themselves all the time.

Overall, in my county, there is a choice of 3 agencies and honestly they are all 1% up or down in any category, which as far as I am concerned, when John Q Public looks at this, they will not get crazy about one percentage point up or down. The agency however scheduled yet another mandatory OASIS inservice, b/c they are very fearful that our referral sources will look at these numbers and decide to go elsewhere. Well, the agencies that scored 5% or more over us, none of them serve our county, and I doubt they will start, b/c first of all, they would need a medicare cert in this county, second of all, they are so far from us, I doubt they would find nurses who wanted to travel so far.

Anyway, when I look at the whole state of nj, I have to say, there really is not that much difference happening. The range of % improvement in bathing is from 47% - 63% (3 are 47%, most are in the mid 50's), range for walking 32% - 47% and meds range 15% (one agency, and a very prestiguious one at that, affluent area, so did they already have good scores on admit?) to 51% (one agency again, serving a very poor community) but avergae range her is 27%-43%. So, really, if you looked at what counties these agencies serve, and grouped them apples to apples, those scores are only 1-2 % apart. Only 2 agencies stand out above the rest.

So, what do you think of this? Do you think it will truly reflect referrals? I think in my other agency in south jersey, it may b/c one of the stand out agencies is our dorect competitor, and we are already hurting for referrals since they underwent a huge merger w another hospital/HH system. But in my county, I see it having NO impact whatsoever.

To see it, go to http://www.medicare.gov and look at "Home Care Compare". That is what the ad says, haven't been to see if it's there yet myself, there wasn't a link I could find when I looked last week.

Thoughts?

Specializes in Home Health.

Well, I tried to edit all my typos, but it sais thread not specified, which is impossible in edit mode. Anyway, has anyone else noticed the HH forum has more bugs since the update than the other forums?? Grrr!!

Specializes in Vents, Telemetry, Home Care, Home infusion.

We were well aware what the MC website would say about our "quality indicators". What you CAN'T tell from those stats is VOLUME of patients served.

One agency at high end, is very small, & serves only Russian speaking clients with less than 100 Medicare admissions/year. While my agency serves average of 200 Medicare patients a MONTH!

So survey results would be different---high volume of patients that we just can't break the habit of going back to ER for every little problem exacerbated by docs who tell the patient "go to the ER" GRRrrrrrrrrrrrr.

Specializes in Home Health.

Exactly Karen. I f you are serving a large city like Phiadelphia, Camden or Newark, narually there will be a higher return to ER stat, as the population tends to be less compliant due to all the social barriers.

I just checked that out for ten agencies, and honestly, they all seem to be a point or teo above or below the national and state averages. I guess that wasn't dramative enough for the newspaper to print. The comparison to the national and state avverages that is.

I'm not worried about it, and I doubt our patients are.

Specializes in MS Home Health.

Karen that was my complaint as well. renerian

Oasis in general is a downer when it comes to qualifying direct nursing services. It is however, preety focused on rehab. What I did at my ex agency was to organize nurse and rehab educators and key field staff to develop a functional rehab. assessment, planning, intervention, eval, and documentation class.At the end nurses were given CBT followed by a test. The pre-test scores were very poor, and indicated that nurses are not inherently able to assess functional deficits and needs as accurately as they should. After this class which also included venders with various devices, the scores for the nurses were in the 90 - 100 range. We saw great improvements in the MO questions that are specific for ADLS, functional deficits, and more accurate placement of rehab. services.I agree with you that there are elements in the compare article that are misleading to the public without further elaboration of the situations which impact for instance improvement in admin. meds. Sometimes just taking meds the same way as before is the optimal outcome. Ptients who alraedy have recieved care will not be fooled by isolated statistics, home care naive clients and naive referral sources may be influenced.

In my mind those data elements are important, but in the back of my mind I sure hope all of those patients understand their disease process, can breathe well enough to perform mandatory adls, are not in pain, and know when to call 911, etc

We just got a copy of our states report this week. I have to say that I do not agree that this is an accurate assessment of any home health agency. I do think that most people that look at the report will assume this is a grade for the agency on a whole instead of looking at what it really is. For me this just means more work at making the agency look better on paper. What we really need is our funding back to where it was before the 1997 Balanced Budget Act so that we can help more people.

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