The Centers for Medicare & Medicaid Services (CMS) released an update to the Home Health Quality Reporting Program (HH QRP) Measure Calculations and Reporting User’s Manual v2.0, the first update since October 2020. The new guide reflects additions, deletions, clarifications, and corrections to language, as well as new exclusions.
Many of the changes to the User Guide include basic updates to terminology, the addition of missing words, updated reference names and clarification of definitions.
The updates reflect the removal of the discontinued Quality Measures:
- Depression Assessment Conducted
- Multifactor Fall Risk Assessment Conducted for all Patients who can Ambulate
- Diabetic Foot Care
- Pneumococcal Vaccine Received
- Improvement in Status of Surgical Wounds
The updates also reflect the addition of new Quality Measures:
- Home Health Within-Stay Potentially Preventable Hospitalization (PPH, PPOBS) – Claims-Based Measure
- Transfer of Health Information to the Patient – OASIS-Based Measure
- Transfer of Health Information to the Provider – OASIS-Based Measure
By far, the most exciting change noted in the HH QRP User Guide V.2.0 is the addition of the denominator exclusion added to OASIS Outcome-Based Quality Measures to exclude patients discharged to a non-institutional hospice.
Effective 1/1/2023, episodes for patients discharged to a non-institutional (home) hospice (M0100 Reason for assessment – RFA 9 Discharge from Agency) where M2420 Discharge Disposition is coded with Response 3 – Patient transferred to a non-institutional hospice are excluded from the calculation of the following OASIS-based quality measures for HH QRP:
- Improvement in Dyspnea
- Improvement in Management of Oral Medications
- Improvement in Bathing
- Improvement in Bed Transferring
- Improvement in Ambulation/Locomotion
With the release of the HH QRP update, it proposed many questions if these updates would apply to Home Health Value-Based Purchasing (HH VBP) items as well. In February 2023, CMS released an additional update with the Expanded HH VBP FAQs and additional new Outcome Measures Tables on the HH QRP site, that brought some much-needed clarification.
The HH VBP FAQs clarified that effective 1/1/2023, episodes for patients discharged to a non-institutional (home) hospice (M0100 Reason for assessment – RFA 9 Discharge from Agency) where M2420 Discharge Disposition is coded with Response 3 – Patient transferred to a non-institutional hospice, and with a M0906 Discharge/Transfer/Death Date of 1/1/2023 or later are excluded from the calculation of the following OASIS-based quality measures in the expanded HHVBP Model:
- Discharged to Community
- Improvement in Dyspnea
- Improvement in Management of Oral Medications
- Total Normalized Composite (TNC) Change Mobility
- Total Normalized Composite (TNC) Change in Self-Care
Furthermore, for Discharge to the Community, episodes where the patient is transferred to an institutional hospice, where M2410 (Which Inpatient Facility has the patient been Admitted) is marked a response 4 Hospice, are excluded in the HHVBP Model (Q3020). Also excluded are episodes where the location is unknown (Q3022).
These updates implement a long-standing request from stakeholders to exclude patients discharged to hospice care from HH QRP. Many agencies are ecstatic to hear of these exclusions. Previously agencies felt they were penalized for accepting patients requiring palliative care, but who were not quite physically or emotionally ready for hospice. CMS continuing to include those patients, who were expected to decline, in the outcomes and star ratings disincentivized agencies from accepting them as patients.
When will agencies see the positive effect of these updates? CMS indicates the updates in the iQIES reports will begin to take effect April 2023. Although the addition of these exclusions on Care Compare went into effect January 1, 2023, the effect will not be seen until January 2024.
Access PDFs of all the new updates to the HH QRP programing on the CMS Home Health QRP website and the Expanded HH VBP site. Available downloads include the HH QRP User Guide V.2.0 and change table, updated CY2023 Specifications for Risk Adjustment, Changes in Skin Integrity, and Potentially Preventable Hospitalizations, revised Home Health Outcome Measures, Process Measures, and Potentially Avoidable Event Tables, as well as Updated Expanded HH VBP FAQs.
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