Astrology is defined as “the study of the movements and relative positions of celestial bodies interpreted as having an influence on human affairs and the natural world”. With the implementation of the Quality of Patient Care Star Ratings in home health, there has been a renewed focus on the data driving the system. The desire to be seen as a great home health agency is understandable but at what point is a line crossed when efforts shift from improving patient care to management of OASIS data points to drive results?

I spent some time today perusing Home Health Compare and was struck by several observations:

  • Agencies reporting 100% on process measures such as pain assessments and depression screening.
    • Our patient population has individuals with significant cognitive issues present and ample narrative documentation indicating inability to understand and follow directions. How can 100% of them be participating as required by a standardized and validated tool??
  • Agencies reporting 99%+ for care planning items such as pain interventions, pressure ulcer prevention and diabetic foot care.
    • In order to select “yes” on M2250, there has to be confirmed specific physician orders within the time frames of the item. With all of the anecdotal complaints regarding the challenges of getting two way communication with the physician, how are scores that high??
  • Agencies reporting 95%+ for timely initiation of care.
    • I hear all the time about delays impacting this issue – longer time in the hospital or SNF or patient/caregiver request to start on a later date. Based on my experience, I’m not seeing clear and consistent documentation that the physician is being made aware and new orders are secured in a timely manner at this high of a rate. We cant just note “per patient request”, go any other date we want and put self selected dates in M102/M104.

I also noted how there tends to be a significant difference between the results of items that an agency can completely control via OASIS data (see above), items that require direct patient assessment (ambulation, bathing, dyspnea), and ones outside agency control (patient satisfaction).Complete control often gets results 95% and higher, patient assessment drops to 60% – 70% and patient satisfaction drops an entire Star level compared to the rest. This pattern raises concern about massaging data as opposed to real care initiatives.

Before assuming I am over reacting, keep in mind that our industry has history in this area. I have had the opportunity to see some of the data analysis CMS uses for decision-making. As an example, how is it that home health patients have such significant issues with dressing and bathing (payment related items) but essentially no issues with grooming and meal preparation (not payment related items)?? How did the average number of therapy visits move from 5 – 7 (pre PPS), to 10 – 13 (in the days of the 10 visit threshold) to significant growth in 14+ and 20+ (in the tiered model)??

As OASIS C2 approached on January 1, 2017, it is a great opportunity to revisit OASIS accuracy – for ALL items – and ensure that both he data collection and the review process are focused on the presentation of the patient.We have to end the astrology approach of letting Stars influence our behavior. That is the only way we can be confident in our own data and as an industry represent the reality of care delivery in the complex environment of home health.