The Centers for Medicare & Medicaid Services (CMS) announced its decision in the home health PPS update for 2013 in the Federal Register to move to claims based acute care hospitalization (ACH) rates because “claims data are a more robust source of data for accurately measuring acute care hospitalization than other data sources.” To date home health ACH rates have been based on agency OASIS data collection. Effective January claims based acute care hospitalization (ACH) rates will be posted on Home Health Compare while home health agencies will continue to receive OASIS-based measures on their agency-specific Certification and Survey Provider Enhancement Reporting system (CASPER) reports. This change mirrors CMS’ earlier decision to report “Emergency Department Use Without Hospitalization” (ED) rates using claims data.
The national average ED rates for home health agencies based on are claims for patients beginning home health care between July 2011 – June 2012 was 11 percent. The rate for ACH rates was 17 percent. Home health agencies were surprised to see such a dramatic drop in the ACH and ED rates. The previously reported national ACH rate was 27 percent. However, this is reflective of the many changes have been made in the rate calculation methodology.
The new Home Health Compare ACH measure reflects the percentage of Medicare fee-for-service home health stays in which patients were admitted to an acute care hospital during the 60 days following the start of the home health stay. Medicaid and Medicare Advantage (MA) patients are not included in the rate. A home health stay is a sequence of home health payment episodes separated from other payment episodes by at least 60 days. Therefore, hospitalizations will not be calculated for recertification episodes and patients will have only one 60 day window for each home health start of care. Planned hospitalizations are excluded from the numerator.
The numerator is the number of home health stays for patients who have a Medicare claims for an admission to an acute care hospital in the 60 days following the start of care. The denominator is the number of home health stays that begin during the 12 month observation period (i.e. for the January 17, 2013 report the period of July 2011-June 2012. Additionally, exclusions from the denominator are stays:
- For patients not continuously enrolled in fee-for-service Medicare for the 60 days following a start of care;
- That begin with a LUPA episode;
- In which the patient receives services from multiple agencies during the first 60 days;
- For patients who are not continuously enrolled in fee-for-service Medicare for the 6 months prior to the home health stay.
The new Home Health Compare “Emergency Department Use without Hospitalization” rates is calculated using the same methodology, with the only exception being that there are no numerator exclusions.
Further information about the claims based utilization measures can be found at: http://www.cms.gov/Medicare/.
CMS intends to “harmonize” measures across provider settings. Therefore, additional measures are under development for claims based re-hospitalization rates that will be created in a manner similar to that for other post-acute care settings. More information will be provided as this CMS proposal develops.