CMS Updates Home Health Compare, Extends Moratoria and Issues Coding Guidance

The Centers for Medicare & Medicaid Services (CMS) has been busy of late, as the agency has recently updated its quality of patient care star ratings, extended its moratoria on new home health care agencies opening and issued coding guidance for fiscal year 2019.

The national average for the Quality of Patient Care Star Rating, which is based on OASIS assessments and Medicare claims data, held at 3.5 stars, according to an analysis by Northampton, Massachusetts-based consulting firm Fazzi Associates.

While the overall average remained steady, the percentage of agencies with 3 and 4.5 stars declined. At the same time, the percentage of agencies with 2 and 5 stars increased, possibly suggesting there is a growing separation between high-scoring and low-scoring providers.

A breakdown of Quality of Patient Care measures specifically shows that 12 measures improved, one worsened and one remained the same, according to Fazzi. Mirroring the last update, the improvement in bed transfer measure saw the biggest bump. Improvement in management of oral medications also showed signs of progress.

Acute care hospitalizations improved ever so slightly in this latest update, improving from 15.9% previously to 15.8%. Urgent, unplanned care in the emergency room saw no change, according to Fazzi.

CMS’ Home Health Compare tool enables consumers to view quality measures and other ratings.

Although the tool has led to greater transparency and offers detailed information on home-based care, it has been noticeably ineffective when it comes to actually driving patients toward high-quality providers, according to the Medicare Payment Advisory Commission.

Home Health Compare results were updated on July 25. CMS typically updates data on a quarterly basis.

The data collection period ranged from Oct. 1, 2016 to Sept. 30, 2017.

National averages for the Home Health Care Consumers Assessment of Healthcare Providers and Systems Survey (HHCAHPS) measures also were updated, though they stayed the same from the previous quarter.

Moratoria extended, coding guidance released

CMS also recently moved to extend its statewide temporary moratoria on opening new Medicare home health agencies in Florida, Illinois, Michigan and Texas.

CMS initially implemented the moratoria back in 2013 in Illinois’ Cook County and Florida’s Miami-Dade County.

The purpose of the moratoria was to discourage fraud, waste and abuse, according to CMS. The agency stated it had consulted with the U.S. Department of Health & Human Services’ Office of Inspector General regarding the extension and determined “significant potential” for wrongdoing continues to exist.

“The circumstances warranting the imposition of the moratoria have not yet abated,” CMS wrote in an announcement.

CMS previously announced a six-month extension of the temporary moratoria in January.

Industry views on the moratoria have been mixed. In the past, LeadingAge has called the moratoria a double-edged sword because it prevents high-quality not-for-profit home health agencies from launching in affected areas.

The moratoria also affect Medicare Part B non-emergency ground ambulance providers and suppliers operating in New Jersey and Pennsylvania.

In other news, CMS and the National Center for Health Statistics released new guidelines for coding and reporting diseases. Guidelines are meant to be used as companion information to the official version of the ICD-10-CM as published on the NCHS website.

ICD-10-CM is a morbidity classification published by the federal government for classifying diagnoses and reasons for visits in all health care settings.

Written by Robert Holly

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Robert Holly
When Robert's not covering the latest in home health care news, you can likely find him rooting for the White Sox or roaming his neighborhood streets playing Pokemon Go. Before joining HHCN, Robert covered everything from big agribusiness to the hottest tech startups. 

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