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 post-acute follow-up care. In 2006, $52 billion was spent in the U.S. on home health care. 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 health care reform bill this number is expected to significantly increase in the future.
Because of the projected increase in demand for home health care services, CMS has 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. The rationale for creating the HHC lie in economic theories that suggest that consumers and businesses make more efficient decisions if they have information that helps them distinguish between low and high quality products. In health care, consumer uncertainty about health care quality has long left them at a disadvantage. CMS designed HHC in hopes of empowering consumer decision-making and improving health care quality.
In the fall of 2003, CMS began posting quality information of all Medicare-certified home health agencies (www.medicare.gov/HHCompare/home.asp). The database is searchable by zip code and provides the percent of patients at each home health agency for each of the following quality measures:
- % who improve ability to bathe themselves
- % who improve ability to get in and out of bed
- % who improve oral medication compliance
- % who experience less pain
- % who improve mobility
- % who need urgent, unplanned medical care
- % who were admitted to a hospital
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 score 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 the five 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. For example, in 2003 non-profit and for-profit agencies were better than the other on some measures; yet, in 2007 the non-profit sector improved in all seven areas, surpassing for-profits on each measure.
The researchers suggest that their findings do not all together 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 help consumers make more discriminating decisions about care. The motivation is especially apparent for agencies that initially had low-quality ratings; the category of home health care that demonstrated the largest improvements since the beginning of HHC.
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.
