1. A journey to excellence

2. The Basics starratingquestions@gmail.com What is Star Rating?
What is a “normal” Star Rating?
How is Star Rating calculated?
When are Star Ratings posted and where?
Scott – financial stability thru clinical appropriateness
Star rating is…” The Quality of Patient Care Star Ratings reflect how Home Health Agencies' (HHA) scores compare with one another on measurements of their quality of patient care performance.”
Normal star rating - Across the country, most agencies fall "in the middle" with 3 stars - delivering good quality of care. A Star Rating higher than 3 means that an HHA performed better than average on the measured care practices and outcomes compared to other HHAs.
How to find star ratings: google “homecare compare”

3. Drug Education on all Medications Provided to Patient/Caregiver
Timely Start of Care
Drug Education on all Medications Provided to Patient/Caregiver
Flu Vaccine Received for Current Flu Season
Improvement in Ambulation
Improvement in Bed Transferring
Improvement in Bathing
Improvement in Pain Interfering With Activity
Improvement in Shortness of Breath
Acute Care Hospitalization
Scott
Some of these are affected by operational procedures, clinical practices and OASIS

4. starratingquestions@gmail.com The Analysis of Findings
Make Groups: For each of the 9 quality measures, the scores are sorted low to high
Assign Group Rating: Each group is assigned an initial ranking from 0.5 to 5.0
Adjust Ratings: Ratings may need to be adjusted if your HHA's score is not statistically different from the two national middle scores of 2.5 and 3.0
Get Average Adjusted Rating: To obtain one overall score for your HHA rather than scores measure-by-measure, the adjusted ratings are averaged across the 9 measures and rounded to the nearest 0.5
Scott
CMS conducts a statistical test of the difference between your HHA's score and the middle score categories of all HHAs for each measure.2 If the test shows your results are not different from the national middle categories in a statistically meaningful way, your initial rating is moved 0.5 closer to the middle categories of 2.5 or 3.0. The rating is moved up 0.5 if your initial rating is below 2.5, or down 0.5 if your initial rating is above 3.0

5. Measure 1: Timely Initiation of Care Clean operations affect this
The Process of Change
Measure 1: Timely Initiation of Care
Clean operations affect this
Sales
Standardized referral form to include all necessary information.
Complete referral information
Intake
Complete intake process with accuracy
Scheduling
Quick communication between these 2 steps
Transition of referral information to clinician
Start of Care
Clinicians who understand the importance of how the pre-SOC process should be – contacting patients early in the day of SOC
Scott’s portion ends/cindy joins me to talk OASIS
Cindy can speak to the trouble spots of these are…not us…but general
Timely Initiation of Care:
Completed at SOC/ROC
(M0030) Start of Care Date:
__ __ /__ __ /__ __ __ __
month / day / year
(M0032) Resumption of Care Date:
__ __ /__ __ /__ __ __ __ ⃞ NA - Not Applicable
(M0102) Date of Physician-ordered Start of Care (Resumption of Care): If the physician indicated a specific start of care (resumption of care) date when the patient was referred for home health services, record the date specified.
__ __ /__ __ /__ __ __ __ (Go to M0110, if date entered)
⃞ NA –No specific SOC date ordered by physician
(M0104) Date of Referral: Indicate the date that the written or verbal referral for initiation or resumption of care was received by the HHA.
__ __ /__ __ /__ __ __ __ month / day / year (M0110)
(M1005) Inpatient Discharge Date (most recent):
month / day / year ⃞ UK
-___ Unknown (M1010) List each Inpatient Diagnosis and ICD-10

6. Measure 2: Drug Education
Measure 2: Drug Education
Completed at TRANSFER/DISCHARGE
(M2015) Patient/Caregiver Drug Education Intervention: At the time of, or at any time since the previous OASIS assessment, was the patient/caregiver instructed by agency staff or other health care provider to monitor the effectiveness of drug therapy, adverse drug reactions, and significant side effects, and how and when to report problems that may occur?
0 - No 1 - Yes
NA - Patient not taking any drugs
Cindy
Therapy can have issues with not completing this…use the internet! Anyone can look up the info and read it back to the patient

7. Measure 3: Flu Vaccine starratingquestions@gmail.com
Completed at TRANSFER/DISHARGE
(M1046) Influenza Vaccine Received: Did the patient receive the influenza vaccine for this year’s flu season?
1 - Yes; received from your agency during this episode of care (SOC/ROC to Transfer/Discharge)
2 - Yes; received from your agency during a prior episode of care (SOC/ROC to Transfer/Discharge)
3 - Yes; received from another health care provider (for example, physician, pharmacist)
4 - No; patient offered and declined
5 - No; patient assessed and determined to have medical contraindication(s)
6 - No; not indicated - patient does not meet age/condition guidelines for influenza vaccine
7 - No; inability to obtain vaccine due to declared shortage
8 - No; patient did not receive the vaccine due to reasons other than those listed in responses 4 – 7
Cindy
Not transporting meds, no premixed vaccine
Homebound/bed bound patients that cant be transported to MD

8. Measure 4: Ambulation starratingquestions@gmail.com
Completed at SOC/ROC/RCT/DC from Agency
(M1860) Ambulation/Locomotion: Current ability to walk safely, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.
0 - Able to independently walk on even and uneven surfaces and negotiate stairs with or without railings (specifically: needs no human assistance or assistive device).
1 - With the use of a one-handed device (for example, cane, single crutch, hemi-walker), able to independently walk on even and uneven surfaces and negotiate stairs with or without railings.
2 - Requires use of a two-handed device (for example, walker or crutches) to walk alone on a level surface and/or requires human supervision or assistance to negotiate stairs or steps or uneven surfaces.
3 - Able to walk only with the supervision or assistance of another person at all times.
4 - Chairfast, unable to ambulate but is able to wheel self independently.
5 - Chairfast, unable to ambulate and is unable to wheel self.
6 - Bedfast, unable to ambulate or be up in a chair.
Cindy
Shirley’s answer to teach this to clinicians…therapy versus nursing scoring
Avoid nurses doing therapy only admits due to losing OASIS points

9. Measure 5: Bed Transferring
Measure 5: Bed Transferring
Completed at SOC/ROC/TRANSFER/DC from Agency
(M1850) Transferring: Current ability to move safely from bed to chair, or ability to turn and position self in bed if patient is bedfast.
0 - Able to independently transfer.
1 - Able to transfer with minimal human assistance or with use of an assistive device.
2 - Able to bear weight and pivot during the transfer process but unable to transfer self.
3 - Unable to transfer self and is unable to bear weight or pivot when transferred by another person.
4 - Bedfast, unable to transfer but is able to turn and position self in bed.
5 - Bedfast, unable to transfer and is unable to turn and position self.
Cindy
Must see the activity and function of the activity

10. starratingquestions@gmail.com Measure 6: Bathing
Completed at SOC/ROC/TRANSFER/DC from Agency
(M1830) Bathing: Current ability to wash entire body safely
0 - Able to bathe self in shower or tub independently, including getting in and out of tub/shower.
1 - With the use of devices, is able to bathe self in shower or tub independently, including getting in and out of the tub/shower.
2 - Able to bathe in shower or tub with the intermittent assistance of another person:
for intermittent supervision or encouragement or reminders, OR
to get in and out of the shower or tub, OR
for washing difficult to reach areas.
3 - Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision.
4 - Unable to use the shower or tub, but able to bathe self independently with or without the use of devices at the sink, in chair, or on commode.
5 - Unable to use the shower or tub, but able to participate in bathing self in bed, at the sink, in bedside chair, or on commode, with the assistance or supervision of another person throughout the bath.
6 - Unable to participate effectively in bathing and is bathed totally by another person.
Cindy
inconsistency

11. Measure 7: Pain and Activity
Measure 7: Pain and Activity
Completed at SOC/ROC/RCT/DC from Agency
(M1242) Frequency of Pain Interfering with patient's activity or movement:
0 - Patient has no pain
1 - Patient has pain that does not interfere with activity or movement
2 - Less often than daily
3 - Daily, but not constantly
4 - All of the time
Cindy
DME company that we are partnering with to assess pain and partner to get a better idea of pain

12. Measure 8: Shortness of Breath
Measure 8: Shortness of Breath
Completed at SOC/ROC/RCT/DC from Agency
(M1400) When is the patient dyspneic or noticeably Short of Breath?
0 - Patient is not short of breath
1 - When walking more than 20 feet, climbing stairs
2 - With moderate exertion (for example, while dressing, using commode or bedpan, walking distances less than 20 feet)
3 - With minimal exertion (for example, while eating, talking, or performing other ADLs) or with agitation
4 - At rest (during day or night)
Cindy
Patient must be moving to assess this

13. Measure 9: Acute Care Hospitalization
Measure 9: Acute Care Hospitalization
No OASIS questions affect this
Determined by claims data
Can we control this?
Messaging with Patients
Technology
Build Rapport
Jessica speak to methods to stop rehospitalization…I just put whatever in there
Care calls, we use data collection vendor alerts, telehealth, standardized call sheet, front load visits for therapy, therapy stacking and daily visits by different disciplines, call me first for patients, chronic disease management info, patient efficiancy
Use of urgent care and SNF admissions versus hospital admits

14. 5 Day-to-Day Change…what it looks like starratingquestions@gmail.com
Increasing Star Rating
Training for managers
Clinical Implementation
Clinical training
Monitoring in Meetings
Review of patient records
Accountability
Seeing the day-to-day details and holding the proper people accountable.
Teach striving for excellence 5
Jessica – here’s where we need to paint a picture of the process that you guys implemented to get the process measures up…what did meetings look and sound like; what specifically was messaged
Clinician and agency Scorecard development with emphasis on each portion to lend to training
Jessica, Pretent that we don’t have SHP

15.
Q & A
Panel Discussion