New research indicates that significant quality improvements have resulted from the reporting initiative in the Medicare program, Home Health Compare (HHC). Researchers at Penn State University analyzed changes in seven quality measures from 2003 to 2007 and found that some measures of care quality improved and others remained unaffected.
Home health care is becoming a more prominent form of care, especially for post-acute follow-up care. In 2006, $52 billion was spent in the U.S. on home health care, and the Centers for Medicare and Medicaid Services (CMS) expect this number to nearly triple over the next six years. The number of Medicare beneficiaries receiving home health services increases by roughly 5% per year, and with the new long-term care provisions in the 2010 health care reform bill, this number is expected to significantly increase in the future.
Because of the projected increase in demand, CMS placed a priority on measuring care quality. The first step was to create the Outcome and Assessment Information System (OASIS) in the 1990s. These data were then utilized to develop Home Health Compare (HHC), which utilizes a subset of OASIS performance measures reported by each home health care agency. CMS designed HHC in hopes of empowering consumer decision making and improving health care quality.
In fall 2003, CMS began posting quality information for all Medicare-certified home health agencies at www.medicare.gov/HHCompare/home.asp. The database is searchable by zip code and provides the percent of patients at each agency for measures such as percent who improve their ability to bathe, to get in and out of bed, and more. Utilizing these measures, researchers were able to track changes in home health care quality since 2003. At the baseline (2003), government-run agencies reported lower-quality care than non-governmental agencies. Among non-government run agencies, non-profit agencies performed better on reductions in emergency care and hospitalizations, while for-profit organizations scored slightly better on medication-management and bathing measures. Overall, hospital-based agencies and agencies with a large proportion of RNs scored higher on the care quality measures than other agencies.
Interestingly, from 2003 to 2007 the researchers found that quality measures related to the daily activities of care management improved significantly, while the use of emergency care remained unchanged and hospitalizations tended to increase. The largest gains in quality occurred in the non-profit sector of home health.
The researchers suggest that their findings do not altogether prove that HHC has had a positive impact on home health quality; however, they do indicate that publically reporting health care quality information has provided agencies with a motivation to improve quality and helps consumers make more discriminating decisions about care. The motivation is especially apparent for agencies that initially had low-quality ratings.
In sum, it appears the initial theoretical justification for the HHC has merit. Not only can HHC help inform consumer decisions, but it also provides a powerful incentive for home health care agencies to focus on meaningful quality improvement initiatives in an effort to compete for clients.
Source: Jun, K., Shea, D., Warner, C. 2010. Journal of Aging and Health Online First March 15, 2010.
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