As Home Health moves steadily towards the Pay for Performance era, the need for certified agencies to embrace and integrate procedures and practices that prompt desired outcomes becomes paramount. Individual clinicians, including therapists, should also take steps to educate themselves regarding this impending quality reform. In addition, they should begin to adapt their care delivery in response to the emphasis on outcomes. The programming and reimbursement principles of the P4P refinements are clear; the system is designed to increase the rate of successful outcomes by providing bonus payments to the highest clinically performing providers. The primary challenge that lies ahead for the homecare industry is how to identify (and implement) required changes in order to achieve under the new system. Those agencies that currently qualify for Elite status (as developed by OCS/DecisionHealth) certainly have a greater understanding of the necessary performance requirements, but all agencies and clinicians need to focus efforts to improve in these areas.
The Home Health Forum will place a decided emphasis on integrating OBQI thoughts and strategies into articles composed throughout 2009. We, not unlike the agencies and clinicians we work with, often find new ways to think about OBQI results in patient programs we currently provide. The deliberate study and resultant focus on the contemporary indicators seems to be all that is required in identifying previously unseen methods of improving outcome scores. As demonstrated in the most recent HHSM article (Respiratory Exercises as a PT Modality in homecare), routines that have only been used in specific instances can be utilized to enhance functional performance in many types of patients.
A review of the OBQI mechanism that exists today would be an appropriate exercise to anchor the focus that the Home Health Forum will take as we prepare for P4P. At the introduction of PPS in 2000, the federal government required that all certified Home Health agencies complete the data collection instrument (OASIS) and report health assessment information for their Medicare clients. CMS has posted portions of the quality-based data on the internet since 2003. Over the next two years, the National Quality Forum, a private non-profit organization, endorsed a group of public reporting measures that are available for all agencies nationally on the Home Health Compare website. These quality data reports are posted quarterly and are reflective of clinical performances for the quarter 6 months prior. In December, 2007, two additional outcomes related to wounds were added to the OBQI scale: more may be added in 2009.
The utilization of these OBQI numbers as the basis of tying a portion of reimbursement to the delivery of quality care mirrors successful programs that have been effective in other areas of healthcare. This Pay for Performance mechanism is currently in the demonstration phase in six states and will, eventually, be introduced to certified agencies as a means of prompting increased care outcomes. How do we re-model care to prepare for this era?
Agencies must take conscious steps to own and embrace their OBQI scores as a valid measure of quality. Most agencies, or their clinicians, are armed with a plethora of excuses or justifications as to why OBQI ratings posted on Home Health Compare don’t tell the real story of their care. I would propose, in contrast, that OBQI scores do, in fact provide an accurate picture of the care offered by any specific provider. An exercise that we recommend for agencies and clinicians is to look up their scores on the Home Health Compare website. Are there any surprises? Any good or bad revelations? Print them out and examine them as you provide care over the next 30 days. Do the realities of your outcome numbers affect your delivery in any way? Next, take any local competitor and assess your opinion of their status as a quality provider. Are they better that your agency? Are they worse? Once you’ve determined your opinion, check their OBQI scores and compare them to your pre-conceived opinion. Any surprises? Do they compare to your agency’s scores in the manner you would have expected?
Exercises and review of OBQI data as described above are only the first steps to outcome improvement. After you own your numbers, you can take steps to improve, modify or celebrate them. But in any case, you will then be prepared to participate successfully in the Pay for Performance era.
Arnie Cisneros is a physical therapist with nearly 25 years of home care experience. He is the owner of Home Health Strategic Management in East Lansing, MI, providers of clinical service management and home care consulting expertise. He is a nationally renowned speaker regarding the PPS refinements of 2008 and therapy utilization under the New Rule.