NQF Recommends Fewer Home Health Quality Measures

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Rhonda Oakes By Rhonda Oakes 
RN, CHPN, Regulatory Analyst, Change Healthcare
NQF Recommends Fewer Home Health Quality Measures

The National Quality Forum (NQF) has recommended removing 14 Home Health Quality Reporting Program measures, citing uniformly high performance for all but one measure. That measure, increase in number of pressure ulcers, has lost NQF’s endorsement.[1]

NQF entered into a contract with the Department of Health & Human Services (HHS) in 2009 to help evaluate and recommend quality measures used by Medicare in public reporting and value-based payment efforts.[2] This is the sixth year the Measure Applications Partnership (MAP) panel has made recommendations.

If accepted, the recommendation would cut the number of measures being reported by about 20%, from the current 79 home health quality reported measures.[3] The report, “Maximizing the Value of Measurement: MAP 2017 Guidance,” was released on March 16, 2017.

For all measures except pressure ulcers, MAP recommended removal because of uniformly high performance with limited variation, what it refers to as topped-out measures. That doesn’t mean the measurement is no longer important, MAP cautions. Most of the measures recommended for removal are related to activities of daily living (ADLs), such as grooming, toileting and bed transfers, as well as education on potential high-risk medications and diabetic foot care, if applicable. However, the uniform high performance means that significant further improvement isn’t possible.

The measures recommended for removal include:

  • Depression assessment conducted
  • Stabilization in grooming
  • Stabilization in bed transferring
  • Stabilization in light meal preparation
  • Stabilization in phone use
  • Stabilization in management of oral medications
  • Stabilization in speech and language
  • Stabilization in cognitive functioning
  • Stabilization in anxiety level
  • Stabilization in toilet transferring
  • Stabilization in toileting hygiene
  • Diabetic foot care and patient/caregiver education implemented during all episodes of care
  • Drug education on high-risk medications provided to patient/caregiver at start of episode
  • Increase in number of pressure ulcers

The recommendation for removal of these measures reflects the high quality of care that many home health organizations uniformly provide to their patients. Educating patients about their conditions and their medications and providing therapy and assistance to help patient regain/stabilize ADLs form the core of quality home healthcare.

“Getting to measures that matter for improving patient care without creating unnecessary administrative burdens is a balancing act,” said Harold Pincus, MD, professor and vice chair of psychiatry at Columbia University and director of quality and outcomes research at New York-Presbyterian Hospital. “To get it right, we need more feedback from patients, frontline doctors and other healthcare professionals on what works and what needs improvement in healthcare quality measurement,” Pincus said in a news release accompanying the report.[4]

According to the release, more than 150 leaders from 90 healthcare organizations or associations whose members routinely use measures participated in MAP discussions, which were voted upon by a panel of 32 members.

“Consumers, patients and purchasers are looking to NQF and MAP to get to the best measures, even if they are difficult to report,” said Helen Burstin, MD, MPH, NQF’s chief scientific officer in the same news release. “They’re counting on us to get it right.”[5]

[1] “Maximizing the Value of Measurement: MAP 2017 Guidance. Final Report. March 15, 2017,” National Quality Forum. Page 16.
[2] http://www.qualityforum.org/projects/ongoing/hhs/
[3] “Maximizing the Value of Measurement: MAP 2017 Guidance. Final Report. March 15, 2017,” National Quality Forum. Page 6.
[4] “NQF’s Measure Applications Partnership Identifies Opportunities to Reduce Measure Burden in Federal Healthcare Programs,” National Quality Forum, dated March 16, 2017, http://bit.ly/2oM6EuR, accessed April 20, 2017
[5] Ibid

One Response to NQF Recommends Fewer Home Health Quality Measures

  1. Joyce Boin says:

    Dr Pincus says it best .. must get to measures that truly positively impact patient.

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