The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #53142

Robert E. Schlenker, PhD, Martha C. Powell, Ph D, and Glenn K. Goodrich, M S. Center for Health Services Research, University of Colorado Health Sciences Center, 1355 S. Colorado Blvd, Suite 306, Denver, CO 80222, 303-756-8350, Bob.Schlenker@uchsc.edu

Medicare-certified home health agencies began collecting standardized patient data in 1999 using the Outcome and Assessment Information Set (OASIS). Medicare also implemented a home health Prospective Payment System (PPS) in October 2000. PPS creates incentives for providers to limit services, with unknown effects on patient outcomes. This analysis examined outcomes for a 300-agency national random sample (approximately 100,000 patient episodes) in 2001, the first calendar year under PPS. Outcomes were measured using data from the national OASIS data repository maintained by the Centers for Medicare & Medicaid Services (CMS). The outcome measures are the patient dichotomies (e.g., improvement in ambulation) that are aggregated to agency-level percentage rates and used in the outcome reports currently provided by CMS for Medicare-certified home health agencies. The outcome rates can be compared to future rates (with appropriate risk adjustment) to assess trends under PPS. For 2001, we found considerable variation across outcomes, suggesting possible areas for system-wide outcome improvement attention. In addition, comparisons of agencies' actual to risk-adjusted predicted outcomes identified groups of related outcomes (e.g., if an agency has a better than predicted improvement rate for one outcome, it is likely to have the same result for other outcomes in the group). Since resource constraints usually limit the quality improvement activities an agency can undertake, this finding suggests that an agency's improvement efforts focused on a few outcomes may have beneficial "spill-over" effects on related outcomes.

Learning Objectives:

At the conclusion of this session, participants will be able to: (
• describe Medicare's home health prospective payment system; (
• explain the outcome measures used in outcome reports provided to home health agencies by the Centers for Medicare & Medicaid Services (CMS); (
• describe the outcome patterns indicated by data for 2001; and (
• identify interrelated outcomes (e.g., an agency will tend to have better than or worse than predicted improvement rates for all outcomes in a group).

Keywords: Home Care, Medicare

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.