HOW PROCESS MEASURES ARE CALCULATED

Transcription

1 HOW PROCESS MEASURES ARE CALCULATED 1) Timely initiation in care (check at SOC and ROC) (5-star) Percentage of home health episodes of care in which the start or resumption of care date was either on the physician-specified date or within 2 days of the inpatient discharge date. Include as met if: a. M0030 (SOC date) is equal to M0102 (physician ordered date) or b. M0032 (ROC date) is equal to M0102 (physician ordered date) or c. M0030 (SOC date) is within 2 days of M1005 (inpatient discharge date) or M0104 (date of referral) or d. M0032 (ROC date) is within 2 days of M1005 (inpatient discharge date) or M0104 (date of referral). (*note: regardless of physician order, ROC must be completed within 2 days of facility discharge) 2) Physician Notification Guidelines Established (check at SOC and ROC)* Percentage of home health episodes of care in which the physician-ordered plan of care, at start/resumption of care, establishes parameters (limits) for notifying the physician of changes in patient status. As of 1/1/2017, this measure is no longer collected by CMS. Exclude if: If M2250 (line a) = na Include as met if: M2250 (line a) = 1 (yes) 3) Depression Assessment Conducted (check at SOC and ROC) (HHCompare) Percentage of home health episodes of care in which patients were screened for depression (using a standardized depression screening tool) at start/resumption of care. Exclude if: M1700 =4 or M1710 = NA or M1720 =NA Include as met if: M1730 = 1, 2, or 3 (Yes responses) 4) Multifactor Fall Risk Assessment Conducted (check at SOC and ROC) (HHCompare) Percentage of home health episodes of care in which patients not designated as non-ambulatory had a multi-factor fall risk assessment at start/resumption of care. Exclude if M1860 (Ambulation) = 04, 05, or 06

2 Include as met if: M0066 indicates that patient is >18 years old at SOC or ROC and M1910 = 1 or 2 (yes responses) 5) Pain Assessment Conducted (check at SOC and ROC) (HHCompare) Percentage of home health episodes of care in which the patient was assessed for pain, using a standardized pain assessment tool, at start/resumption of care. Include as met if: M1240 = 1 or 2 (yes responses) 6) Pressure Ulcer Risk Assessment Conducted (check at SOC and ROC) (HHCompare) Percentage of home health episodes of care in which the patient was assessed for risk of developing pressure ulcers at start/resumption of care. Include as met if: M1300 = 1 or 2 (yes responses) 7) Depression interventions in POC (check at SOC and ROC)* Percentage of home health episodes of care in which patients with depression symptoms/diagnosis had a physician-ordered plan of care that includes interventions such as medication, referral for other treatment, or a monitoring plan for current treatment. As of 1/1/2017, this measure is no longer collected by CMS. Exclude if: If M2250 (line d) = na Include as met if: M2250 (line d) = 1 (yes) and patient hasn t been scored as nonresponsive for M1710 or M1720 8) Diabetic Foot Care and Patient Education in Plan of Care (check at SOC and ROC) Percentage of home health episodes of care in which the patient is diabetic and the physician-ordered plan of care includes regular monitoring for the presence of skin lesions on the lower extremities and patient education on proper foot care. Exclude if: M2250 (line b) = na Include as met if: M2250 (line b) = 1 (yes) 9) Fall Prevention Steps in Plan of Care (check at SOC and ROC)* Percentage of home health episodes of care in which interventions to mitigate the risk of falls were included in the physician-ordered plan of care for patients assessed to be at risk for falls. As of 1/1/2017, this measure is no longer collected by CMS. Exclude if: M2250 (line c) = na Include as met if: M2250 (line c) =1 (yes) 10) Pain intervention in Plan of Care (check at SOC and ROC)*

3 Percentage of home health episodes of care in which intervention(s) to monitor and mitigate pain were included in the physician-ordered plan of care for patients who were identified as having pain. As of 1/1/2017, this measure is no longer collected by CMS. Exclude if: M2250 (line e) = na Include as met if: M2250 (line e) =1 (yes) 11) Pressure Ulcer Prevention in Plan of Care (check at SOC and ROC) (HHCompare) Percentage of home health episodes of care in which interventions to prevent pressure ulcers were included in the physician-ordered plan of care for patients assessed to be at risk for pressure ulcers. Exclude if M2250 (line f) = na Include as met if: M2250 (line f) =1 (yes) 12) Pressure Ulcer Treatment in Plan of Care (check at SOC and ROC)* Percentage of home health episodes of care in which pressure ulcer treatment based on principles of moist wound healing was specified in the physician-ordered plan of care (or an order was requested) for patients who have pressure ulcers with need for moist wound healing. As of 1/1/2017, this measure is no longer collected by CMS. Exclude if: M2250 (line g) = na Include as met if: M2250 (line g) =1 (yes) 13) Depression Intervention During All Episodes of Care (check at Transfer and Discharge)* Percentage of home health episodes of care during which the patient has symptoms or diagnosis of depression and depression interventions were included in the physician-ordered plan of care and implemented (since the previous OASIS assessment). As of 1/1/2017, this measure is no longer collected by CMS. For assessments later than 1/1/2017. Exclude if: M2401 (line c) = na Include as met if: M2401 (line c) = 1 (yes) and patient has not been scored as unresponsive on M1710 or M1720 For assessments prior to 1/1/2017. Exclude if: M2400 (line c) = na Include as met if: M2400 (line c) = 1 (yes) and patient has not been scored as unresponsive on M1710 or M ) Diabetic Foot Care and Patient/Caregiver Education During All Episodes of Care (check at Transfer and Discharge) Percentage of home health episodes of care in which diabetic foot care and education were included in the physician-ordered plan of care and implemented for patients with diabetes (since the previous OASIS assessment). For assessments 1/1/2017 or later. Exclude if: M2401 (line a) = na Include as met if: M2401 (line a) = 1 (yes)

4 Foe assessments prior to 1/1/201. Exclude if: M2400 (line a) = na Include as met if: M2400 (line a) = 1 (yes) 15) Heart Failure Symptoms Addressed During All Episodes of Care (check at Transfer and Discharge) Percentage of home health episodes of care during which patients exhibited symptoms of heart failure and appropriate actions were taken (since the previous OASIS assessment). For assessments 1/1/2017 or later. Include as met if: M1501 = 1 (yes) and M1511 = 1, 2, 3, 4, or 5 For assessments prior to 1/1/2017. Include as met if: M1500 = 1 (yes) and M1510 = 1, 2, 3, 4, or 5 16) Pain Interventions Implemented During All Episodes of Care (check at Transfer and Discharge) Percentage of all home health episodes of care during which the patient had pain and pain interventions were included in the physician-ordered plan of care and implemented (since the previous OASIS assessment). For assessments 1/1/2017 or later. Exclude if: M2401 (line d) = na Include as met if: M2401 (line d) = 1 (yes) For assessments prior to 1/1/2017. Exclude if: M2400 (line d) = na Include as met if: M2400 (line d) = 1 (yes) 17) Treatment of Pressure Ulcers Based Upon Principals of Moist Wound Healing Implemented During All Episodes of Care (check at Transfer and Discharge)* Percentage of home health episodes of care during which pressure ulcer treatment based on principles of moist wound healing was included in the physician-ordered plan of care and implemented for patients with pressure ulcers needing moist healing (since the previous OASIS assessment). As of 1/1/2017, this measure is no longer collected by CMS. For assessments 1/1/2017 or later. Exclude if: M2401 (line f) = na Include as met if: M2401 (line f) = 1 (yes) For assessments prior to 1/1/2017. Exclude if: M2400 (line f) = na Include as met if: M2400 (line f) = 1 (yes) 18) Drug Education on High Risk Medications Provided to Patient/Caregiver at Start of Episode (check at SOC and ROC)

5 Percentage of home health episodes of care in which patients/caregivers were educated about high-risk medications at start/resumption of care including instructions on how to monitor the effectiveness of drug therapy, how to recognize potential adverse effects, and how and when to report problems. As of 1/1/2017, this measure is no longer collected by CMS. Exclude if: M2010 = na Include as met if: M2010 = 1 (yes) 19) Drug Education on All Medications Provided to Patient/Caregiver During All Episodes of Care (check at Transfer and Discharge) (5-star and VBP) (HHCompare) Percentage of home health episodes of care during which patient/caregiver was instructed on how to monitor the effectiveness of drug therapy, how to recognize potential adverse effects, and how and when to report problems (since the previous OASIS assessment). Exclude if: M2016 = na Include as met if: M2016 =1 (yes) 20) Fall Prevention Step Implemented During All Episodes (check at Transfer and Discharge) Percentage of home health episodes of care during which interventions to mitigate the risk of falls were included in the physician-ordered plan of care and implemented, for patients at risk of falls (since the previous OASIS assessment). For assessments 1/1/2017 or later. Exclude if: M2401 (line b) =na Include as met if: M2401 (line b) = 1 (yes) For assessments prior to 1/1/2017. Exclude if: M2400 (line b) =na Include as met if: M2400 (line b) = 1 (yes) 21) Potential Medication Issues Identified and Timely Physician Contact During All Episodes (check at Transfer and Discharge)* Percentage of home health episodes of care during which the patient's drug regimen was assessed to pose a risk of significant adverse effects or drug reactions and whose physician was contacted within one calendar day (since the previous OASIS assessment). Assessments 1/1/2017 or later. Exclude if: M2005 = na Include as met if: M2005 = 1 (yes) Assessments prior to 1/1/2017. Exclude if: M2004 = na Include as met if: M2004 = 1 (yes) 22) Pressure Ulcer Prevention Implemented During All Episodes of Care (check at Transfer and Discharge). (HHCompare) Percentage of home health episodes of care during which interventions to prevent pressure ulcers were included in the physician-ordered plan of care and implemented for patients assessed to be at risk for pressure ulcers (since the previous OASIS assessment). For assessment 1/1/2017 or later. Exclude if: M2401 (line e) = na Include as met if: M2401 (line e) = 1 (yes) For assessments prior to 1/1/2017. Exclude if: M2400 (line e) = na Include as met if: M2400 (line e) = 1 (yes)

6 23) Potential Medication Issues Identified and Timely Physician Contact at Start of Episode (check at SOC and ROC)* Percentage of home health episodes of care in which the patient's drug regimen at start/ resumption of home health care was assessed to pose a risk of clinically significant adverse effects or drug reactions and whose physician was contacted within one calendar day. As of 1/1/2017, this measure is no longer collected by CMS. Assessments 1/1/2017 or later. Include as met if: M2003 = 1 (yes) Assessments prior to 1/1/2017. Include as met if: M2002 = 1 (yes) 24) Influenza Immunization Received for Current Flu Season (check on Transfer and Discharge) (5- star and VBP) (HHCompare) Percentage of home health episodes of care during which patients received influenza immunization for the current flu season. Include as met if: Any of the episode of care falls between October 1 st and March 31 st and M1041 = 1 (yes) and M1046 = 1, 2, or 3 25) Influenza Immunization Offered and Refused (check on Transfer and Discharge) Percentage of home health episodes of care during which patients were offered and refused influenza immunization for the current flu season Include as met if: Any of the episode of care falls between October 1 st and March 31 st and M1041 = 1 (yes) and M1046 = 4 26) Influenza Immunization Contraindicated (check on Transfer and Discharge) Percentage of home health episodes of care during which patients were determined to have medical contraindication(s) to receiving influenza immunization. Include as met if: Any of the episode of care falls between October 1 st and March 31 st and M1041 = 1 (yes) and M1046 = 5 27) Pneumococcal Polysaccharide Vaccine Ever Received (check on Transfer and Discharge)(VBP) (HHCompare) Percentage of home health episodes of care during which patients were determined to have ever received Pneumococcal Polysaccharide Vaccine (PPV). Include as met if M1051 = 1 (yes) 28) Pneumococcal Polysaccharide Vaccine Offered and Refused (check on Transfer and Discharge)

7 Percentage of home health episodes of care during which patients were offered and refused Pneumococcal Polysaccharide Vaccine (PPV). Include as met if: M1051 = 0 (no) and M1056 = 1 (offered and declined) 29) Pneumococcal Polysaccharide Vaccine Contraindicated (check on Transfer and Discharge) Percentage of home health episodes of care during which patients were determined to have medical contraindication(s) to receiving Pneumococcal Polysaccharide Vaccine (PPV), Include as met if: M1051 = 0 (no) and M1056 = 2 (assessed and determined to be contraindicated)