Home Health Quality Measures

Quality Measures Used in the Home Health Quality Reporting Program

The following three categories of quality measures are used in the Home Health Quality Reporting Program (HH QRP):

1. Outcome measures
2. Process measures; and
3. Patient reported outcome measures

This page contains brief descriptions of each measure type and how the data for that measure is calculated. The Downloads section below provides links to technical documentation, tables identifying which Home Health Quality Measures are risk-adjusted and reported publicly, and additional resources.

Questions about home health quality measures may be sent to HomeHealthQualityQuestions@cms.hhs.gov.

Outcome Measures

Outcome measures assess the results of health care that are experienced by patients. The data for the Home Health outcome measures are derived from 2 sources: (1) data collected in the Outcome and Assessment Information Set (OASIS) submitted by home health agencies; and (2) data submitted in Medicare claims.

Measures based on OASIS data are calculated using a completed episode of care that begins with admission to a home health agency (or a resumption of care following an inpatient facility stay) and ends with discharge, transfer to inpatient facility or, in some cases, death. Measures based on home health claims data are calculated based on the first home health claim that starts an episode of care for a patient and ends either 30 or 60 days after the initial claim, across an entire episode of care, or during the period of time following discharge (see section titled Claims-Based Measures below).

Many home health outcome measures are risk-adjusted. Risk-adjusted outcome measures are identified in the Home Health Outcome Measures Table (PDF) which is available in the Downloads section below. The risk adjustment methodology, using a predictive model developed specifically for each measure, compensates for differences in the patient population served by different home health agencies.

The HH QRP measures and the broader list in the Home Health Quality Initiative, include four types of Outcome measures:

1. Improvement measures (i.e., measures describing a patient's ability to get around, perform activities of daily living, and general health),
2. Measures of potentially avoidable events (i.e., markers for potential problems in care),
3. Utilization of care measures (i.e., measures describing how often patients access other health care resources either while home health care is in progress or after home health care is completed), and
4. Cost/Resource measures

For a list of home health outcome measures, please refer to the Home Health Outcome Measures Table, which can be located via the link for Home Health Measures Tables in the Downloads section below. Technical Specifications for calculating OASIS-based outcome measures, patient-related characteristics measures, and the factors used to risk adjust outcome measures, can be accessed via the link for Technical Documentation of OASIS-Based Measures in the Downloads section below.

Process Measures

Process measures evaluate the rate of home health agency use of specific evidence-based processes of care. The HH process measures focus on high-risk, high-volume, problem-prone areas for home health care. These include measures pertaining to all or most home care patients, such as timeliness of home care admissions.

Process measures are derived from data collected in the OASIS submitted by home health agencies and are calculated using a completed quality episode that begins with admission to a home health agency (or a resumption of care following an inpatient facility stay) and ends with discharge, transfer to inpatient facility or sometimes death.

Unlike the outcome measures, process measures are not risk-adjusted. Risk adjustment is not considered to be necessary for process measures because the processes being measured are appropriate for all patients included in the denominator (patients for whom the measure is not appropriate are excluded).

The Home Health Process Measures include the following:

• Timely Initiation of Care
• Percent of Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function
• Influenza Immunization Received for Current Flu Seasons
• Influenza Immunization Offered and Refused for Current Flu Season
• Influenza Immunization Contraindicated
• Drug Regimen Review Conducted with Follow-Up for Identified Issues
• Transfer of Health Information to the Patient
• Transfer of Health Information to the Provider

For more information about these process measures, please refer to the Home Health Process Measures Table, which can be located via the link to Home Health Measures Tables in the Downloads section below. Technical documentation for calculating process measures can be accessed via the link to Technical Documentation of OASIS-Based Measures in the Downloads section below.

Patient Reported Outcome Measures

The HHCAHPS measures are derived from a 34-question survey. The survey:

• Collects feedback from current or recently discharged home health agency patients (or their family or friends) about their experiences with a home health agency
• Is the first national standard for collecting information on home health agency patient experiences that allows for valid comparisons between home health agencies
• Has a core set of questions
• Allows home health agencies to add their own customized questions to the survey to support internal customer service and quality-related activities

CMS groups the HHCAHPS measures by topic into three composite measures and two overall measures. CMS publicly reports the HHCAHPS measures, and they are called “patient survey results" on the Care Compare website. The five measure areas are: (1) Care of Patients, (2) Communications between Providers and Patients, (3) Specific Care Issues, (4) Overall Rating of Care, and (5) Patient willingness to recommend HHA to family and friends. For more information on the HHCAHPS measures and the HHCAHPS survey, visit https://homehealthcahps.org/.

Data sources for the HH QRP Measures

CMS utilizes a range of data sources to calculate quality measures. HH QRP measures derive from three data sources, Outcome and Assessment Information Set (OASIS) assessment, Medicare fee-for-service (FFS) claims, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Home Health Care Survey. OASIS (patient quality of care) and HH CAHPS (patient survey results) data collection and reporting are requirements for providers participating in the HH QRP. Medicare FFS claims data are submitted by HHAs to receive payments for services provided to Medicare FFS patients.

Assessment-based measures

Most HH QRP measures are assessment-based measures created using the OASIS assessment tool data. OASIS-based measures are created using counts of HH quality episodes and can be either process our outcomes measures. OASIS-based process measures are not risk-adjusted to show how often home health agencies give recommended care or treatments that research shows get the best results for most patients. OASIS-based outcome measures are risk adjusted using available OASIS-based data elements.

Claims-based measures

Claims-based measures are a subset of home health outcome measures. We calculate them using Medicare fee-for-service (FFS) claims data. There are two types of claims-based measures: 1) claims-based utilization measures and 2) claims-based cost/resource use measures.

Claims-based utilization measures

Claims-based utilization measures provide information related to the use of health care services (e.g., hospitals, emergency departments, etc.) resulting from a change in patient health status. They are calculated using:

• The first home health claim starts an episode of care for a patient, and, as appropriate, the claim for the period after discharge.
• Negative events like potentially avoidable hospitalizations or emergency department care, or a lack of such negative events.

These measures use healthcare utilization data to indicate whether patients achieved a successful outcome of care (e.g., Discharge to Community) or, instead, whether they have unresolved care needs. In most cases, lower values are better than higher values because they show fewer adverse outcomes for patients after receiving home health care. These are the five claims-based utilization measures:

1. Acute Care Hospitalization During the First 60 days of Home Health (ACH)
2. Emergency Department (ED) Use without Hospitalization During the First 60 Days of Home Health
3. Discharge to Community (DTC)
4. Potentially Preventable 30-Day Post-Discharge Readmission (PPR)
5. Home Health Within-Stay Potentially Preventable Hospitalization (PPH)

Claims-based cost/resource use measure

The HH QRP also includes one measure of cost/resource use:

• Medicare Spending per Beneficiary – Post-Acute Care (MSPB-PAC) Home Health.

This measure assesses the Medicare spending of a home health agency, compared to the average Medicare spending of home health agencies nationally for the same performance period.

Home Health Measures not included in the HH QRP

Potentially Avoidable Event (PAE) measures are a subset of outcome measures that are derived from OASIS data but are not a part of the HH QRP. PAE measures were developed as part of the Outcome-Based Quality Improvement (OBQI) initiative that preceded the HH QRP. PAE measures are not reported on Care Compare but are available to HHAs via IQIES reports. Potentially avoidable events serve as markers for potential problems in care because of their negative nature and relatively low frequency. The potentially avoidable events reported are outcome measures, in the sense that they represent a change in health status between start or resumption of care and discharge or transfer to inpatient facility. All potentially avoidable event measures are adjusted for variation in patient characteristics.

For a list of potentially avoidable event measures, please refer to the Home Health PAE Measures Table, which can be located via the link to the Home Health Measures Tables in the Downloads section below.

Technical documentation for calculating potentially avoidable event measures can be accessed via the link to Technical Documentation of OASIS-Based Measures in the Downloads section below. The Downloads section also has a link for the Outcome-Based Quality Monitoring Manual which contains additional information about the PAE measures.

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