In a world where home health agencies are scored, reviewed and tested in so many different ways, providers need to know which quality measures hold the most weight.
That’s especially the case today, when more care models shift toward value.
“It is extremely important for providers to understand — especially if you’re trying to do some education with your staff — where you want to start and what you want to concentrate on in order to get the best bang for your buck,” Lisa McClammy, a senior clinical education consultant with MAC Legacy, said during a webinar Thursday. “There are common items among STAR ratings, value-based purchasing and even PDGM. Understanding the overlap is a good way to figure out where you can get started.”
MAC Legacy is a Denton, Texas-based home health and hospice coding and consulting company.
McClammy used the final rule from the U.S. Centers for Medicare & Medicaid Services (CMS) as a way to introduce some of the nuances the agency uses to calculate value-based care outcomes.
One of the biggest movers is the timely initiation of care because of how slim the margin for error is.
“For you to get a 5 STAR rating with timely initiation of care, you have to be 100%,” McClammy said. “For you to get a 4.5 STAR, you have to be 99.9%. The point being is that for timely initiation of care, everyone’s improved to the point where to be ranked at the highest level, you have to be 100% — so it’s extremely important that you get this right.”
A point of emphasis agencies need to make is ensuring that the start of care date is accurate and delivering care on that exact date to avoid missteps.
Another critically important aspect of the STAR ratings is the referral date.
“What they’re going to use is the inpatient discharge date to calculate timely initiation of care,” McClammy said. “When you’re thinking about your timely initiation of care, are you getting that patient started timely within 48 hours of that discharge from a facility? Or within 48 hours of that community referral? When you’ve only got seven measures that are determined in your STAR rating, you want to make sure that you’re working on all of those measures.”
One of the coming major changes in the HHVBP model is CMS’ replacing of two normalized composite measures around self-care and mobility with a discharge function score.
At the same time, the discharge community measure has been replaced with the discharge to community post-acute measure.
Now and in the future, it’s prudent that agencies and their clinicians understand how to properly fill out those measures in OASIS in order to get the right reimbursement.
“Where the clinicians seem to get a little bit mixed up is the formal assistive services,” McClammy said. “We all want to think that if a patient is getting services in the community then it would be considered formal assistive services. But in HHVBP, the only two answers that would be considered formal assistive services is skilled care through another home health agency or if an agency has to discharge and readmit a patient because of a payer change. Those are the only two things.”
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