HOW HOME HEALTH COMPARE ITEMS ARE CALCULATED

Transcription

1 HOW HOME HEALTH COMPARE ITEMS ARE CALCULATED PERIOD OF STUDY: Home Health Compare and Process Measures will be calculated based upon your Dashboard selections including Payer Sources, Teams, Case-Managers, Physicians, or Diagnoses selected. Additionally, the Dashboard dates will determine the episodes and assessments that are included in the calculations. For Process Measures which are included in Home Health Compare, assessments captured by Dashboard selection dates will be included. For Home Health Compare measures that require a comparison of responses on multiple assessments; episodes will be included if the Discharge or Transfer in included in the Dashboard selections and the SOC or ROC occurred within the preceding 12 months. MANAGING DAILY ACTIVITIES HOW OFTEN PATIENTS GET BETTER AT WALKING OR MOVING AROUND 3. Exclude if, on SOC or ROC M1860 = 0 (as patient has no potential to improve). 4. Compare response for M1860 on each of the assessments. 5. Include as improved, if response is lower on discharge.

2 HOW OFTEN PATIENTS GOT BETTER AT GETTING IN AND OUT OF BED 3. Exclude if, on SOC or ROC M1850 = 0 (as patient has no potential to improve). 4. Compare response for M1850 on each of the assessments. 5. Include as improved, if response is lower on discharge. HOW OFTEN PATIENTS GOT BETTER AT BATHING 3. Exclude if, on SOC or ROC M1830 = 0 (as patient has no potential to improve). 4. Compare response for M1830 on each of the assessments. 5. Include as improved, if response is lower on discharge. MANAGING PAIN AND TREATING SYMPTOMS HOW OFTEN THE HOME HEALTH TEAM CHECKED PATIENT FOR PAIN 2. Include as best practice had been met, if M1240 = 01 or 02 (yes responses) HOW OFTEN HAS THE HOME HEALTH TEAM TREATED PATIENTS PAIN 2. For assessments 1/1/2017 or later. Include as best practice had been met if, M2401 line d = Exclude if M2401 line d = NA. 4. For assessments prior to 1/1/2017. Include as best practice had been met if, M2400 line d = Exclude if M2400 line d = NA.

3 HOW OFTEN PATIENTS HAD LESS PAIN WHEN MOVING AROUND 3. Exclude if, on SOC or ROC M1242 = 0 (as patient has no potential to show improvement). 4. Compare response for M1242 on each of the assessments. 5. Include as improved, if response is lower on discharge. HOW OFTEN THE HOME HEALTH TEAM TREATED HEART FAILURE PATIENTS SYMPTOMS 2. Assessments 1/1/2017 or later. Include as best practice had been met if, M1501 = 01 and M1511 = 1, 2, 3, 4, or Assessments prior to 1/1/2017. Include as best practice had been met if M1500 = 01 and M1510 = 1, 2, 3, 4, or 5. HOW OFTEN PATIENTS BREATHING IMPROVED (DYSPNEA) 2. Exclude if, on SOC or ROC M1400 = 0 (as patient has no potential to improve). 2. Compare response for M1400 on each of the assessments. 3. Include as improved, if response is lower on discharge.

4 TREATING WOUNDS AND PREVENTING PRESSURE SORES HOW OFTEN PATIENTS WOUNDS IMPROVED OR HEALED AFTER AN OPERATION 2. Exclude from consideration if M1340 = 00 at SOC or ROC. 3. Include as improved, if at discharge M1342 is lower than SOC or ROC; or if M1340 = 0. HOW OFTEN THE HOME HEALTH TEAM CHECKED PATIENTS FOR THE RISK OF DEVELOPING PRESSURE SORES 2. Include as best practice has been met if, M1300 = 01 or 02 (yes responses). HOW OFTEN THE HOME HEALTH TEAM INCLUDED TREATMENTS TO PREVENT PRESSURE SORES IN THE POC 2. Include as best practice has been met if, M2250 line f = Exclude if M2250 line f = NA. HOW OFTEN THE HOME HEALTH TEAM TOOK DOCTOR-ORDERED ACTION TO PREVENT PRESSURE SORES 1. Check each Transfer (06 and 07) and Discharge that meets Dashboard selections. 2. Assessments 1/1/2017 or later. Include as best practice has been met if, M2401 line e = Exclude if M2401 line e = NA. 4. Assessments prior to 1/1/2017. Include as best practice has been met if, M2400 line e = Exclude if M2400 line e = NA.

5 PREVENTING HARM HOW OFTEN THE HOME HEALTH TEAM BEGAN THEIR PATIENTS CARE IN A TIMELY MANNER (5-STAR AND PROCESS MEASURE) 2. Include as best practice has been met if: a. M0030 is equal to M0102 or b. M0030 is within 2 days after M1005 or c. M0032 is within 2 days after M1005 (Note: regardless of Physician orders, ROC must be completed within 48 hours of facility discharge). HOW OFTEN THE HOME HEALTH TEAM TAUGHT PATIENTS (OR THEIR FAMILY) ABOUT THEIR DRUGS (5-STAR, VBP, AND PROCESS MEASURE) 2. Include as best practice has been met if, M2015 = 01 (yes). 3. Exclude if M2015 = NA. HOW OFTEN PATIENTS GOT BETTER AT TAKING THEIR DRUGS CORRECTLY BY MOUTH 3. Exclude if, on SOC or ROC M2020 = 0 (as patient has no potential for improvement). 3. Compare response for M2020 on each of the assessments. 4. Include as improved, if response is lower on discharge.

6 HOW OFTEN THE HOME HEALTH TEAM CHECKED PATIENTS RISK OF FALLING 2. Exclude if patient is non-ambulatory. M1860 = 4, 5, or Include as best practice has been met if, M1910 = 1 or 2 (yes responses) HOW OFTEN THE HOME HEALTH TEAM CHECKED PATIENTS FOR DEPRESSION 2. Exclude if M1700 = 4, M1710 = NA, or M1720 = NA (indicating patient is non-responsive). 3. Include as best practice has been met if, M1730 = 1, 2, or 3 (yes responses) HOW OFTEN THE HOME HEALTH TEAM DETERMINED WHETHER PATIENTS RECEIVED FLU SHOT FOR THE CURRENT FLU SEASON. (5-STAR, VBP AND PROCESS MEASURE) 2. Consider only if any portion of care occurs during flu season, October 1 st through March 31 st. 3. Include as best practice has been met if: M1046 = 1, 2, or Exclude if M1046 = 6. HOW OFTEN THE HOME HEALTH TEAM DETERMINED WHETHER THEIR PATIENTS RECEIVED A PNEUMOCOCCAL VACCINE (VBP AND PROCESS MEASURE) 1. Check each Transfer (06 and 07) and Discharge that meets Dashboard selections. 2. Include as best practice has been met if: M1051 = 1.

7 FOR PATIENTS WITH DIABETES, HOW OFTEN THE HOME HEALTH TEAM GOT DOCTOR S ORDERS, GAVE FOOT CARE, AND TAUGHT PATIENTS ABOUT FOOT CARE 2. Assessments 1/1/2017 or later. Include as best practice has been met if, M2401 line a = 1 (yes). 3. Exclude if M2401 line a = NA. 4. Assessments prior to 1/1/2017. Include as best practice has been met if, M2400 line a = 1 (yes). 5. Exclude if M2400 line a = NA. PREVENTING UNPLANNED HOSPITAL CARE HOW OFTEN PATIENTS RECEIVING HOME HEALTH CARE NEEDED ANY URGENT, UNPLANNED CARE IN THE HOSPITAL EMERGENCY ROOM WITHOUT BEING ADMITTED TO THE HOSPITAL (VBP) ***CMS uses Claims for this calculation. For timeliness purposes, Home Health Gold uses OASIS data to replicate the calculations as closely as possible. In accordance with the Claims based rules, only patients with M0150 are included in our calculations*** 1. If Transfer or Discharge meets Dashboard selections. 2. Exclude if patient has been in care > 60 days. 3. Exclude if the episode is a LUPA. 4. For assessments 1/1/2017 or later. Include as needed unplanned care without being admitted if: M2301 = For assessments prior to 1/1/207. Include as needed unplanned care without being admitted if: M2300 = 01.

8 HOW OFTEN HOME HEALTH PATIENTS HAD UNPLANNED HOSPITAL ADMISSION IN FEWER THAN 60 DAYS (VBP) ***CMS uses Claims for this calculation. For timeliness purposes, Home Health Gold uses OASIS data to approximate this measure. In accordance with the Claims based rules, only patients with M0150 are included in our calculations*** 1. If Transfer or Discharge meets Dashboard selections. 2. Exclude if patient has been in care > 60 days. 3. Exclude if the episode is a LUPA. 4. Exclude if M2430 (Reason for Hospitalization) = 19 (Scheduled Treatment or Procedure). 5. Include as Admitted to the Hospital if: M2410 = 1. Additional Measure DISCHARGED TO THE COMMUNITY (VBP) 1. If Discharge or Transfer (07) meets Dashboard selections. 2. Include as Discharged to Community if M2420 = 1 or 2.