The CMS has brought home the idea of giving patients access to healthcare quality data-literally. The new nationwide home health quality initiative announced last week expands the agency's overall healthcare quality campaign, which began last year with a similar mandatory program for nursing homes.
Last month, the first results from the National Voluntary Hospital Reporting Initiative also were made public, though the CMS expressed displeasure at the participation level of hospitals in that effort and threatened to make it mandatory if more facilities don't release their data.
Similar to the nursing home program, the home health quality program-which expands a pilot program begun in the spring in eight states-is designed to help consumers make better choices about home health agencies and spur the industry to improve itself. An estimated 7,000 home health agencies participate in Medicaid and Medicare.
That total represents slightly more than one-third of the nation's home health agencies, but those not included in the program are far smaller than those that are, officials said.
Quality reporting "is a personal bias of mine," CMS Administrator Tom Scully told Modern Healthcare. "I think that offering patient and consumer information is the most important thing Medicare can do (for its beneficiaries). Hopefully, this is a legacy we will leave to the healthcare system. I think drawing attention to this changes behavior. We'll keep pushing as hard as we can."
While the home health initiative is part of a larger quality strategy, HHS Secretary Tommy Thompson said there was another reason the announcement was so important: Improving the quality of home care may spur more beneficiaries to take advantage of a far more cost-effective alternative to nursing home care.
According to a survey released in August by the MetLife Mature Market Institute, the national average hourly cost for a home healthcare aide was $18.12, compared with the $181.24 average daily cost of a private room in a nursing home. The institute, based in Westport, Conn., is run by Metropolitan Life Insurance Co., New York.
Though Medicare normally doesn't pay for nursing home services except for short post-hospital stays, it projects it will spend roughly the same amount on payments to nursing homes, $13.6 billion, as on home-care services in fiscal 2003. However, home health industry officials said many seniors don't need the 24/7 care provided in a nursing home.
"The vast majority of patients can be taken care of more cost-effectively in the home. We believe there are many patients who can be diverted from nursing homes if there were more home health services available," said Ann Howard, director of federal policy for the American Association for Homecare in Alexandria, Va.
Given that it had no choice in reporting data to federal regulators, the home health industry threw its support firmly behind the launch.
Val Halamandaris, president of the National Association for Home Care & Hospice in Washington, said the quality initiative "appears to be a step in the right direction. We can never say enough that the patient and his or her needs come first in home care. Determining the right combination of useful information will require ongoing effort."
The publicizing of quality data may be new, but the CMS' effort to improve home care is not, officials said last week. Medicare quality improvement organizations have been lending their technical expertise to help home health providers do their jobs better. According to the American Health Quality Association in Washington, about 5,000 home health agencies had received training from QIOs through October with half of them developing plans of actions to improve care.
"We believe the combination of public reporting and technical assistance from the QIOs will motivate and support providers in their efforts to improve care," said David Schulke, executive vice president of the quality association.
Early results indicate that the QIOs are having an effect. Shore Healthcare at Home in Onley, Va., decreased its acute-care hospitalization rate by 19% over a one-year period after training with a QIO while Columbia Montour Home Health Service in Bloomsburg, Pa., improved its patients' ability to get in and out of bed on their own from 30% to 49.2% after working with a QIO.
A QIO helped Lifeline Home Health Care in Sarasota, Fla., improve its rate of healing surgical wounds by 29%.
"It's all about providing quality patient care," said Diane Yarber, quality consultant for Lifeline. "That's the bottom line."
Though the initiative is supposed to educate consumers and spur them to be more proactive in choosing a home health agency, Yarber said she had not seen much evidence of that as no patients have told her they chose Lifeline after going online to compare different agencies. Florida was one of the original states that participated in the initiative's test project launched in the spring.
To get the word out, HHS placed ads with sample results in 69 papers across the country last week.
Information on 11 measures are available on the Web at medicare.gov, including rates of hospitalization for patients who received home healthcare and improvements in getting dressed and bathing without assistance.
-With Mark Taylor