Currently Viewing:
The American Journal of Managed Care October 2018
Putting the Pieces Together: EHR Communication and Diabetes Patient Outcomes
Marlon P. Mundt, PhD, and Larissa I. Zakletskaia, MA
Primary Care Physician Resource Use Changes Associated With Feedback Reports
Eva Chang, PhD, MPH; Diana S.M. Buist, PhD, MPH; Matt Handley, MD; Eric Johnson, MS; Sharon Fuller, BA; Roy Pardee, JD, MA; Gabrielle Gundersen, MPH; and Robert J. Reid, MD, PhD
From the Editorial Board: Bruce W. Sherman, MD
Bruce W. Sherman, MD
Recent Study on Site of Care Has Severe Limitations
Lucio N. Gordan, MD, and Debra Patt, MD
The Authors Respond and Stand Behind Their Findings
Yamini Kalidindi, MHA; Jeah Jung, PhD; and Roger Feldman, PhD
The Characteristics of Physician Practices Joining the Early ACOs: Looking Back to Look Forward
Stephen M. Shortell, PhD, MPH, MBA; Patricia P. Ramsay, MPH; Laurence C. Baker, PhD; Michael F. Pesko, PhD; and Lawrence P. Casalino, MD, PhD
Nudging Physicians and Patients With Autopend Clinical Decision Support to Improve Diabetes Management
Laura Panattoni, PhD; Albert Chan, MD, MS; Yan Yang, PhD; Cliff Olson, MBA; and Ming Tai-Seale, PhD, MPH
Medicare Underpayment for Diabetes Prevention Program: Implications for DPP Suppliers
Amanda S. Parsons, MD; Varna Raman, MBA; Bronwyn Starr, MPH; Mark Zezza, PhD; and Colin D. Rehm, PhD
Clinical Outcomes and Healthcare Use Associated With Optimal ESRD Starts
Peter W. Crooks, MD; Christopher O. Thomas, MD; Amy Compton-Phillips, MD; Wendy Leith, MS, MPH; Alvina Sundang, MBA; Yi Yvonne Zhou, PhD; and Linda Radler, MBA
Medicare Savings From Conservative Management of Low Back Pain
Alan M. Garber, MD, PhD; Tej D. Azad, BA; Anjali Dixit, MD; Monica Farid, BS; Edward Sung, BS, BSE; Daniel Vail, BA; and Jay Bhattacharya, MD, PhD
Currently Reading
CMS HCC Risk Scores and Home Health Patient Experience Measures
Hsueh-Fen Chen, PhD; J. Mick Tilford, PhD; Fei Wan, PhD; and Robert Schuldt, MA
Gatekeeping and Patterns of Outpatient Care Post Healthcare Reform
Michael L. Barnett, MD, MS; Zirui Song, MD, PhD; Asaf Bitton, MD, MPH; Sherri Rose, PhD; and Bruce E. Landon, MD, MBA, MSc

CMS HCC Risk Scores and Home Health Patient Experience Measures

Hsueh-Fen Chen, PhD; J. Mick Tilford, PhD; Fei Wan, PhD; and Robert Schuldt, MA
Risk adjustment for patient experience measures needs to be modified by including the CMS Hierarchical Condition Categories (HCC) risk scores of home health beneficiaries.
ABSTRACT

Objectives: To understand the association between agency-level CMS Hierarchical Condition Categories (HCC) risk scores and patient experience measures for home health.

Study Design: This was a cross-sectional study.

Methods: We extracted variables from the 2014 Medicare Provider Utilization and Payment Data for Home Health Agencies and Home Health Compare file. We applied fixed-effects models for the analyses. Our dependent variables included both global and composite patient experience measures. The 2 global patient experience measures were the patient’s overall rating of care provided by the agency (rating) and the patient’s willingness to recommend the home health agency to others (recommendation). The 3 composite patient experience measures were how often the patient felt the provider gave care in a professional way (professional way), how well the home health team communicated with the patient (communication), and whether the home health team discussed medicines, pain, and home safety with the patient (discussion).

Results: Increased agency-level CMS HCC risk scores were negatively associated with all patient experience measures: rating (–2.04; P ≤.001), recommendation (–2.75; P <.001), professional way (–1.56; P <.001), communication (–1.67; P <.001), and discussion (–1.69; P ≤.001). Several covariates, including the percentage of racial/ethnic minority beneficiaries, ownership of the agency, and number of tenured years with the Medicare program, were significantly associated with patient experience measures.

Conclusions: A negative association exists between CMS HCC risk scores and patient experience measures. To avoid unintended consequences, patient experience measures need further risk adjustment under the CMS 5-star patient survey rating system and the Home Health Value-Based Purchasing pilot program.

Am J Manag Care. 2018;24(10):e319-e324
Takeaway Points
  • The Home Health Compare website uses patient experience measures to construct a 5-star patient survey rating system for the public. These measures are also quality performance metrics used in the Home Health Value-Based Purchasing (HHVBP) pilot program.
  • Increases in CMS Hierarchical Condition Categories risk scores were negatively associated with patient experience measures for home health at the agency level.
  • Evaluating the practice patterns of home health agencies and monitoring access to care for racial/ethnic minorities and beneficiaries with complicated clinical conditions under the 5-star patient survey rating system and HHVBP pilot program is recommended.
Patient experience is a critical quality dimension of healthcare and is also associated with patient outcomes, such as patient safety and readmissions.1-3 In 2010, CMS used the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey to assess patient experience for home health care.4 In 2016, CMS used the results from the HHCAHPS survey to create a 5-star patient survey rating system and made it publicly available.5 Patient experience is also part of quality metrics in the Home Health Value-Based Purchasing (HHVBP) pilot program that financially rewards or penalizes home health agencies in 9 states.6

In the United States, about 12,000 home health agencies deliver care to approximately 3.5 million Medicare beneficiaries at their residences.7 Medicare home health beneficiaries are homebound and often experience polypharmacy.7-9 They have, on average, 4.2 diagnostic conditions and have a higher prevalence of limitations in activities of daily living and cognitive function than general Medicare beneficiaries.10,11 Most of them receive assistance from informal caregivers to meet their medical and daily needs.12 Home health providers not only conduct professional care (eg, physical therapy and wound care) but also educate beneficiaries and their informal caregivers about how to conduct safe care (eg, proper use of medications and oxygen inhalation) and coordinate necessary resources to meet patients’ needs and expectations at home.

Evidence from surveys for health plans, hospitals, community health centers, and primary care physicians shows that several factors affecting patient experience are beyond health providers’ control. The most common factors are patient sociodemographics, self-reported health status, depression, survey language, mode of survey (eg, mail or telephone interview), and whether the survey was completely by a proxy.13-20 Other studies focusing on hospital care found that patients with high severity of illness and complicated conditions were likely to have lower ratings of patient experience than their counterparts. They concluded that risk factors used in patient experience for hospital care insufficiently adjusted for clinical conditions that affected patient experience ratings.21-23

In home health, CMS and the HHCAHPS coordination team reported that the factors associated with patient experience are (1) patient sociodemographics, including age and education; (2) self-reported health status; (3) whether patients live alone; (4) self-reported mental/emotional status; (5) non-English survey response; (6) a diagnosis of schizophrenia or dementia/cerebral degeneration; and (7) whether the survey was completely by a proxy.24 These 7 factors are currently used to adjust patient experience for the 5-star patient survey rating system and the HHVBP pilot program. A study also found that minorities had lower ratings of patient experience for their home health care.25

Medicare home health beneficiaries are among the most vulnerable Medicare populations. Whether the risk factors currently used by CMS adequately adjust patient experience for home health care is largely unknown. Our study aimed to fill this critical knowledge gap by examining the interplay between agency-level CMS Hierarchical Condition Categories (HCC) risk scores (details in Methods section) and the patient experience metrics. We used the agency-level CMS HCC risk score as a proxy variable for the clinical and functional conditions of home health beneficiaries within home health agencies. Associations between patient experience measures and agency-level CMS HCC risk scores from our study provide critical information about whether the current risk-adjusted model for patient experience measures needs modification.

METHODS

Data Sources

We merged 2 national Medicare databases at the home health agency level, the 2014 Medicare Provider Utilization and Payment Data for Home Health Agencies (PUPDHHA) and the 2014 Home Health Compare file.26,27 The PUPDHHA provides several agency-level variables based on 100% of Medicare enrollment and fee-for-service claims data during the 2014 calendar year.28 These variables include an agency-level HCC risk score based on the HCC risk scores from all of the beneficiaries cared for by a particular home health agency, provider identification number, number of distinct beneficiaries without a low-utilization payment episode (with ≤4 home health visits during an episode of home health care, namely, up to 60 days), and number of beneficiaries from different racial/ethnic groups.

The Home Health Compare file is updated quarterly by CMS.27 It consists of provider identification numbers and patient experience measures extracted from the HHCAHPS survey. The Home Health Compare file also provides characteristics of home health agencies, including ownership and CMS certification year. We extracted agency-level patient experience measures based on data collected from January 1, 2014, through December 31, 2014.


 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up