Transforming Home Healthcare – 8 th Scope of Work

1. Transforming Home Healthcare – 8th Scope of Work LT David Dietz Task 1b Government Task Leader ddietz@cms.hhs.gov

2. February 16 – Chester River Home Health and Hospice visit • Meeting the needs of HHAs • Structure/focus of visits • Timeliness • Processes/systems that fit their needs • Data/results

3. Transformational Change • Change which enables an HHA to deliver care meeting the goals of safety, effectiveness, efficiency, timeliness, patient-centeredness and equity • Results from the implementation of 4 strategies: • Measure and report performance • Adopt HIT and use it effectively • Redesign care process • Transform organizational culture

4. Home Health Quality Improvement Priorities for 8th SoW - Possibly • Achieve specified reduction in failure rates for acute hospitalization (IPs and statewide) • Achieve specified reduction in failure rates for the publicly reported OASIS measures (IPs and statewide) • Achieve a specified improvement rate for immunization assessment (statewide) • Implement and utilize telehealth

5. Effective Use of Resources • Maximize available resources (e.g., MedQIC, QIOSC, collaboration with other Task 1 sub-tasks) • Share resources within the QIO community – this is a national program, not a state one • Integrate communications and consistent program messages • Share learning and promote successes – this is a national program, not a state one

6. Acute Care Hospitalization - Possibly • Based on 23% best attainable rate (75th percentile of 7th SoW Round 1 IPs) • 50% Reduction in failure rate for IPs (e.g., 27% - 25%) • 30% Reduction in failure rate for statewide • IPs must work with this measure • This is also a mandatory statewide measure • If a state has a rate less than or equal to 23%, they may develop their own plan for reducing acute care hospitalization (to be approved by PO and GTL)

7. Publicly Reported OASIS Measures - Possibly • Target reduction in failure rates, based on 75th percentile of 7th SoW Round 1 IPs • Target reduction in failure rates based on 90% best attainable rate (100% for status of surgical wounds) • If the performance for the QIO’s state/jurisdiction for statewide work or IP work is greater than or equal to 90% (minus acute care and status of surgical wounds, the QIO shall work on a different measure) • IPs will work on one of their choosing; regarding the statewide, the QIO will choose the measure • Emergent care is excluded

8. Statewide Immunization Work - Possibly • Goal: to incorporate influenza and pneumococcal immunizations into HHAs comprehensive patient assessments • Two surveys conducted – Sept 2006, the other measuring improvement, Nov 2007 • Goal: to achieve a 50% improvement from baseline to remeasurement, measuring the percent of HHAs that have incorporated these immunizations into their comprehensive patient assessment, including offering these vaccinations as well as providing follow-up consultation if necessary

9. Telehealth IP Specifics - Possibly • Implement or utilize telehealth as a tool to reduce acute care hospitalization • May include telemedicine (i.e., audio consultation, phone messages) or telemonitoring (i.e., audio/video/data consultation) • Shall meet CMS Telehomecare Clinical Guidelines (developed by Quality Insight of PA), to be released summer of 2005 • Evaluation would include both an implementation and acute care hospitalization component (greater RFR than non-telehealth IPs)

10. IP HHA Size Requirements - Possibly • HHA size based on OBQI reports • Small HHAs – less than 90 episodes annually • Medium HHAs – 91-350 episodes annually • Large HHAs – 351+ episodes annually • Minimum requirements: • 10% Small HHAs • 10% Medium HHAs • 15% Large HHAs *If a state/jurisdiction is unable to meet these requirements, it must demonstrate so to both the PO and GTL

11. Substitution Clause - Possibly • The QIO may select up to 10 additional HHAs to work with on identified participant activities. The QIO may substitute 1 or more of these 10 HHAs at the time of evaluation only if a) an IP has gone out of business, or b) changed ownership (changes based on PRS )

12. 8th Scope of Work – QIOSC Competition • Scope of work is completed, request for proposals soon to follow • Open competition to all • Consider your resources before you submit a technical proposal…… • Consider your reasons before you submit a technical proposal……

13. The 4 QIO Commandments • We live and die by the numbers • We must constantly report quantitative estimates of our activities and accomplishments • We must demonstrate performance difference between identified participants and statewide • We must enjoy and like to do this!

14. 7th Scope of Work, Rounds 1 and 2 • 36 Total states rounds 1 and 2 • 22 States scored .95 or better • 14 States did not reach .95 !!!!

15. How Do We Prove QIO Program is Effective? • Identified participant performance based on NUMBERS • Direct correlation between QIO efforts and positive improvement in the data

16. How Do We Prove QIOs Are Efficient? • Shared resources developed by QIOSC • Less duplication in efforts • Shared learning = shared success stories • National improvement

17. EVERYONE IS RESPONSIBLE FOR ULTIMATE SUCCESS WE ARE A NATIONAL PROGRAM WE MUST SUCCEED NATIONALLY