It seems like only yesterday that home health representatives sat down with the CMS (formerly HCFA) to discuss developing a hypothetical data set that would somehow measure outcomes of care. Medicare was under Congressional pressure to produce such information and home health personnel, particularly clinicians, were eager to see patient care measures substituted for process measures that often placed form over substance in the Medicare survey process.
It's taken more than a decade, but OASIS has become the realization of that intention. While there is certainly room for improvement in the OASIS data set and ways to further reduce unnecessary burden, we are rapidly moving into an environment in which the patient care we provide will be measured in terms of outcomes driven by OASIS data.
Throughout OASIS development it was clear agencies would be obligated to use these data in self-evaluation activities. OASIS would become the tool that agencies would use to identify areas for improving care and would then verify progress through OASIS data changes. While the level of procedural detail included in the OBQI process was not anticipated, the notion of clinicians using OASIS data to guide their internal process of continuous quality improvement was intrinsic.
What could not have been anticipated was that CMS would accelerate from the early use of OASIS and OBQI to a process of publicly reported quality measures, a de facto report card on agency performance. When CMS announced its "Quality Initiative" VNAA accepted the invitation of CMS to participate in the process.
We have urged that measures be carefully adjusted to account for differences in agency case mix and that the measures not just be those on which data are most valid and reliable, but that the measures be those most clearly actionable. This input is reflected in large measure (but not completely) in the 11 quality measures chosen for the eight states in the April Phase One Quality Initiative.
Because home care nurses live every day in the real world of their patients, with all the variation of conditions, responses to treatment, compliance to care, etc., reducing an agency's performance to a handful of quality indicators can be challenging. This concern is heightened when an even smaller subset is to be published in area papers and read by consumers who have little understanding of what we do.
As professionals we need to help the public better understand home health and what these measures mean by putting the reported measures in the context of all home health factors. We then can tell the story of what home care means for people-a story well worth telling.
As we work to improve our patients' care, we must provide continuous feedback to CMS on the ways OASIS and OBQI can be changed to better capture meaningful outcomes. Then, over time, quality measures will become less of a report card, but a resume to establish the unique community contributions home care provides.
For more information on the association, publications, meetings, and any other questions, contact:
VNAA
99 Summer Street Suite 1700
Boston, MA 02110
(617) 737-3200 voice
(617) 737-1144 fax
http://www.vnaa.org