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Posts tagged ‘HHCAHPS’

Improving HHCAHPS Scores


On January 28, Medicare announced that home health agencies will be given stars based on their Home Health CAHPs scores.  You can see yours on Home Health compare.  When you find your agency on home health compare, there will be three tabs at the top.  On the third tab that reads, Patient Survey Results, you will see the responses that your patients gave in response to the HHCAHPS survey.

In order to have a response, at least 40 patients must be completed.  Data for agencies with 40 through 99 completed surveys is issued with a caution that reads:

Fewer than 100 patients completed the survey. Use the scores shown, if any, with caution as the number of surveys may be too low to accurately tell how an agency is doing.

In browsing the agencies in areas where I work, there is an alarming number of agencies that have no data submitted for the time period being reported.  The only exemptions from the HHCAHPS requirement are those agencies that have served less than 60 patients.  If your agency has a footnote stating no data was submitted for the reporting period, bring it to the administrator and Director’s attention immediately.  The Agency will be ineligible for future payment updates and may sustain a penalty.

Most agencies have information available.  Using a standardized questionnaire with neutral assistance from a paid vendor, patients are asked among other things, if:

  • They were told in advance of the services they would receive
  • Somebody from the agency asked to see all their medications’
  • Someone talked to them about all their medications
  • They were shown how to set up their home so they could move about
  • The agency seemed up to date about care and treatment
  • Their pain was assessed
  • The agency informed them about when they would be visiting

This is a partial list but should you want it all, you can find in multiple languages here.    Note that many questions are about how well the agency communicated with the patient.  Other questions from the survey assessed if the patients feel as though the agency respected them, addressed patient concerns, listened to the patient, communicated in way the patient could understand and if the agency treated them as gently as possible.

The survey concludes by asking the patient or representative if they would refer the agency to family or friends and how well, on a scale of 1 – 10 did the agency perform.

A few things to know.

Patients should not be prompted about the survey.  If the visiting staff does their job, there is no need to ‘prep’ the patient.  The agency should not use any of the questions in agency literature or marketing venues.  Example:  Choose Julianne’s Home Health where you will be treated with courtesy and respect and always know when your nurse will arrive.  Medicare thought it was important to tell you that you should not pay the patients to answer the survey.  Finally, should you choose to have a separate patient satisfaction survey, you should not use the same questions.  (Please don’t duplicate efforts!)

Luckily, once a contract with a Vendor has been signed, there is not a lot for the agency to do until reports are received.  Someone else does the survey, aggregates the results and puts them in a report for you.  Agencies are obligated to contract with a vendor and obviously, vendors must be paid.  You might as well use the data.  I am stunned by the number of nurses who are lost when talking about HHCAHPS.

My only Vendor experience is with Deyta and I never saw the need to investigate further. This is not to say that other vendors are not equally as qualified but I’m a consultant; not a personal shopper.  The fact that Deyta was so easy to work with and responsive to questions by email and phone gave me no reason to find other vendors.  They have recently been acquired by HealthcareFirst but it is not a requirement that HCF software is used to benefit from Deyta’s services.

In reviewing random and not so random star ratings, the responses across the board seem to be very high.  As such, any score under 92 percent should be taken seriously.  Include supervisory visits with RNs as well as LPNs to watch them communicate.  Do not assume that if a nurse comes across the wrong way to a patient that it is the nurse who needs to improve. The patient may have their own issues but when friction occurs, remove the nurse if you can.*  If you review your complaint log, you will likely find that poor communication is the root of most patient complaints.

Elderly people confined to the home may look forward to the nurse’s visit because they are alone more often than not.  Being late without calling upsets some patients more than bad lab results or a new diagnosis.  Really paying attention to the patient and hearing what they are saying is one way to show a patient how important they are.  Everyone deserves to be heard and if your visiting staff has one foot out the door to the next visit from the minute she arrives, the patient may feel as though they were not heard and become fearful that the nurse is missing something important they are trying to say.  Remember, the patient’s needs are not always documented on a plan of care.

Many of these results are improved by simple kindness, good southern manners and good care.  Shouldn’t those factors be the very minimum in your hiring requirements?  Even if you’re from up North?

Patient Dissatisfaction

What do HHCAHPS surveys really mean? Are they useful in home health and hospice? Read yet another controversial viewpoint from Haydel Consulting Services.

Read more

Data Submission


Have you submitted your OASIS data?  All of it?  Have you looked at your validation reports in great detail to ensure that there was not one fatal error that may have been overlooked?

What about your HHCAHPS data?  Have you been diligent about submitting it?  If your agency had less than 60 patients from March 31 through April 1, have you submitted an exemption request on the HHCAHPS website?

If you are not 100 percent sure about these answers, it might be a really good time to find out and ensure that  you have met your data submission requirements.  You will be penalized if your OASIS and/or HHCAHPS data isn’t submitted.

The penalty sounds modest enough – 2 percent.  But unless you are really good at doing business or really bad at taking care of patients, that 2 percent could be anywhere from 20 to 50 percent of your margin.  If you are really good at taking care of patients and mediocre in the business area, this modest 2% could devastate you.

The Medicare Guidance, which can be found here, reads:

In calendar year 2007 and each subsequent year, if a home health agency does not submit required quality data, their payment rates for the year are reduced by 2 percentage points.

Notice the reference to the year 2007?  The actual reg has been in effect even longer than that and only a couple of agencies here and there were penalized.  The Office of the Inspector General took notice of that earlier in the year and penalties are on the way.  The  Medicare Administrative Contractors (MAC’s – formerly FI’s also known as Palmetto, Pinnacle, etc.) have received these instructions straight from CMS:

Each fall, Medicare contractors with home health workloads will receive a technical direction letter (TDL) which provides a list of HHAs that have not submitted the required OASIS and/or HHCAHPS data during the established timeframes. These Medicare contractors shall review their paid claims history for claims which have:

  • a provider on the (naughty) list
  • Dates of service from July of the previous year
  • Beneficiaries over 18

Here’s the part that is really good:

If the contractor finds any such claims, the contractor shall notify the HHAs that they have been identified as not being in compliance with the requirement of submitting quality data and are scheduled to have Medicare payments to their agency reduced by 2%.

I have yet to see where a threshold for compliance has been set.  It does not say if the majority of data was submitted or if 90 percent of the data was received.

It also doesn’t say how they are going to identify the providers.  Will they look for gaps longer than 3o days between submissions?

My experience is not reassuring.  Agencies have received deficiency notices for late submissions but there have a number of times over the past few years when no data was submitted.  Nothing has been received when no data was submitted.

In one agency, a young lady had indeed submitted the data and placed the validation reports in a binder just as she was told.  Her instructions should have included reading the reports.  Every single assessment had been rejected for a period of six months.

Several times in several different agencies, the person responsible for data submission left employment.  When they did, nobody picked up the relatively insignificant task of transmitting data.

If I were an administrator or a Director, you can prevent disaster by:

  • Requiring OASIS data to be submitted every two weeks.  It is not unheard of that uploading data is difficult and time consuming
  • Require written confirmation that the task was done.
  • If you use outlook, put a recurring reminder with an email that goes out two days before data is to be uploaded.  That way, if you forget about all this a year from now and the person uploading the data leaves, you will get a bounced email
  • Actually look at validation reports and ensure they are being addressed.
  • A system of verifying with your HHCAHPS vendor that submission of data has occurred according to your contract.

If you are a field nurse or someone else who doesn’t deal with OASIS transmission, don’t hesitate to bring a copy of this to the people who do to remind them of the importance of it.  If they are offended, walk it off as my son’s coaches used to say.  I can pretty much guarantee that you will not get a raise next year if your agency takes a 2 percent hit.

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