Removal of Flu Vaccine Measure to Boost Home Health Star Ratings

Home health agencies participating in the Centers for Medicare and Medicaid Services’ (CMS) Quality of Patient Care (QoPC) Star Rating program could see a slight uptick in their average ratings on Home Health Compare, thanks to CMS’ proposed removal of the influenza immunization measure.

Currently, home health agencies must be able to report on five of the nine total measures for which CMS rates agencies as part of the QoPC Star Rating program.

These nine measures include items like timely initiation of care, drug education on medication, improvement in ambulation and whether the patient received influenza immunization for the current flu season.


Continued improvement

The impetus to remove the influenza immunization measure stems from the agency’s overall goal to continually improve the ratings program, according to Alan Levitt, MD, medical officer of the Division of Chronic and Post-Acute Care at CMS.

Levitt, along with Sara Galantowicz, senior associate at Abt Associates, a Cambridge, Massachusetts-based global research company contracted by CMS, presented on the proposed change during a webinar Thursday.


“We convened an expert panel to [analyze] how the measures were performing and then make decisions on how to make the ratings better,” Levitt said during the webinar. “In the meantime, we’d also received feedback from home health agencies that felt that the flu vaccination measure—[while] useful in terms of information for patients and family members to have on the Home Health Compare website—was not a measure that was able to show performance of home health agencies to be used in the calculation of star ratings.”

Impact of removal

The October 2017 refresh of Home Health Compare reflected the overall performance of 9,194 agencies, with an average rating of 3.25 out of a possible five-star rating.

In a simulation removing the measure, 9,147 agencies reported with an average rating of 3.27, according to Galantowicz.

“The reason for this very slight fall in reportability is because currently, an agency must have five of the nine measures [reported],” she explained. “With the influenza immunization measure removed, the threshold changes, and agencies must have five of the eight measures available to receive a star rating.”

On average, the removal of the flu vaccination will affect reportability only slightly, while the star ratings average will increase, according to Galantowicz.

“The increase can be seen among both rural and urban agencies, and small and larger agencies,” she said.

CMS received 24 comments during its public comment period regarding the proposed removal, with 100% of agencies supporting the move.

Projected timeline

“Based on this input, CMS is finalizing its proposal to remove the influenza immunization received for current flu season measure from the QoPC star rating,” Galantowicz said.

The removal will be effective with the April 2018 refresh of Home Health Compare, with a preview report reflecting the change to be distributed in January 2018.

However, the flu vaccine measure will still be collected as part of the Outcome and Assessment Information Set (OASIS) and will continue to be utilized by CMS in other capacities, according to Levitt.

“[The flu vaccine measure] will continue to be reported on Home Health Compare even after being removed from the algorithm, and will be monitored to determine whether removal from star ratings impacts vaccination rates,” Galantowicz added.

Written by Carlo Calma

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