5-STAR TRAININGPROGRAM

How to Improve Your Home HealthStar Rating

OVERVIEW OF HOME HEALTH STARRATING

For all Medicare-Certified Home Health Agencies

Began February 2015 with website scoring July 2015

Key Tool to Consumers and Insurance Agencies to Determine anAgency’s Quality of Patient Care

Updated quarterly

Star Rating begins when an agency has at least 20 complete“episodes of care” and have been certified for at least 6 months.

OVERVIEW OF HOME HEALTH STARRATING

Does not include Medicaid/Medical and Medicare Advantage Patients

In some states their reimbursement may be dependent on the scoring of the starsystem. (Value-Based Programs)

COMPONENTS OF 5-STAR RATINGS

The Quality of Patient Care Star Rating-based on Startof Care, Discharge and Transfer OASIS and MedicareClaims Date. (9 Measures)

Patient Survey Star Rating-Completed for eachagency by a CMS-approved contractor based onthe patient’s experience of care measures.

QUALITY OF PATIENT CARE STAR RATING3 PROCESS MEASURES

9 of 27 current reported process (green sectionson the SOC and Discharge OASIS) measuresTimely Initiation of Care (M0102, M0104)Drug Education on all Medications Provided to

Patient/Caregiver (M2000, M2002, M2010) Influenza Immunization Received for Current Flu

Season (M1040) (Discharge OASIS)

QUALITY OF PATIENT CARE STAR RATING6 OUTCOME MEASURES

Compare SOC to DCO Improvement in Ambulation (M1860) Improvement in Bed Transferring (M1850) Improvement in Bathing (M1830) Improvement in Pain Interfering with Activity (M1240, M1242) Improvement in Shortness of Breath (M1400)Acute Care Hospitalization (M2410) (Transfer OASIS)

5-STAR COMPONENTS ONSTART OF CARE,DISCHARGE OASIS ANDTRANSFER OASIS

PROCESS MEASURE #1TIMELY INITIATION OF CARE

The Referral Date is pulled from the Patient Profile. Please ensure date is accurate. If a start of care has been initiated within 48 hours of the referral you would check the “N/A”

box in M0102. If start of care is more than 48 hours from referral, for what ever reason, (family request,

family member not available, MD appointment, etc.) the SOC date would be entered inM0102. In addition, a new verbal physician order is initiated and the written order reflectsthe new Start of Care listed on M0101. You then skip to M0110.

Then remove the date in M0104 (following the skip patter)

PROCESS MEASURE #2DRUG EDUCATION ON ALL MEDICATIONSPROVIDED TO PATIENT/CAREGIVER

Go to medication profile and click on the third column “Medications(Info/Interactions)” and ifthere is anything that comes up as a drug interaction or duplicate therapy, cut and paste on anMD order and send to MD as an “FYI”. This is not an order, so does not require signature.

M2000 should never be 0

It M2000 is 2 then answer M2002 as a Yes

PROCESS MEASURE #2DRUG EDUCATION ON ALL MEDICATIONSPROVIDED TO PATIENT/CAREGIVER

M2000 What to Report Duplicate Medications Moderate/Severe Drug Interactions Dosage Errors Noncompliance Any Side Effects

M2010 High Risk Medications- Default to Yes because the list is very long (see attachment) examplesinclude: Hypoglycemics Anticoagulants Opioids Cardiac Respiratory

Documentation should reflect that patient/caregiver was educated on what and how toreport medication problems to the HHA and physician

PROCESS MEASURE #3INFLUENZA IMMUNIZATION RECEIVED FORCURRENT FLU SEASON

FOUND IN THE Discharge OASIS on page 2. Applies to patients admitted between the dates Oct.1- March 31 we answer

yes to this question. If the patient is admitted prior to Oct.1, but is discharged in during Oct.1 –

March 31, we must answer the question yes M1046 we must ensure the patient has received the flu vaccine or find a way

to get it for them or it will count against us.

OUTCOME MEASURE #1IMPROVEMENT IN AMBULATION

Rating based on comparison between SOC OASIS and DC OASIS. There must be improvement recorded to increase star rating. Assessment should be based on:

Patient’s lowest ability in 24 hour period Ambulation on a variety of surfaces Both observation and interview

Regardless of use of assistive device any ‘hands on’ should be scored ‘3’ Count ‘furniture walking’ as 2 or 3 If unsafe and scores high on Timed Up and Go (>13 seconds) score 3

OUTCOME MEASURE #2IMPROVEMENT IN BED TRANSFER

Rating based on comparison between SOC OASIS and DC OASIS.

There must be improvement recorded to increase star rating.

Assessment should be based on: Patient’s lowest ability in 24 hour period

Patient’s ability to bear the majority of their weight during the transfer

Both observation and interview

Minimal human assistance means both verbal and physical hands on

OUTCOME MEASURE #3IMPROVEMENT IN BATHING

Rating based on comparison between SOC OASIS and DC OASIS. There must be improvement recorded to increase star rating. Assessment should be based on:

Patient’s lowest ability in 24 hour period Both observation and interview Based on equipment they currently have not what they may get

Excludes washing face, hands and shampooing hair If they have a non-functioning bath/shower or cannot climb stairs to the

bath/shower score them 3, 4 or 5.

OUTCOME MEASURE #4IMPROVEMENT IN PAIN INTERFERING WITHACTIVITY

M1240-A standardized assessment should be: Wong-Baker 1-10 pain scale for cognitively intact patients. Please

complete and upload to chart. Adult Nonverbal Pain Scale (NVPS) for cognitively impaired patients

(attached) Please complete and upload to chart.

M1242-If patient requires assistance when in pain then cannotscore #1.

OUTCOME MEASURE #4IMPROVEMENT IN PAIN INTERFERING WITHACTIVITY

When reviewing patient's medications, the presence of medication for pain orjoint disease provides an opportunity to explore: Presence of pain When pain is most severe Activities when pain is present and frequency during the activities

Be careful not to overlook the lack of involvement in activities because fear ofpain (E.g. sitting in chair all day, not performing ADLs such as bathing, dressing,walking)

Assessing pain in a nonverbal patient involves observation of facial expression(e.g., frowning, gritting teeth), monitoring heart rate, respiratory rate, perspiration,pallor, pupil size, irritability, or use of visual pain scales (e.g., FACES).

The patient's treatment for pain (whether pharmacologic or non-pharmacologic)must be considered when evaluating whether pain interferes with activity ormovement. Ask patient what happens if miss pain medications.

Pain that is well controlled with treatment may not interfere with activity ormovement at all but ensure all clinicians are scoring accurately

OUTCOME MEASURE #5IMPROVEMENT IN SHORTNESS OF BREATH

If the patient uses oxygen continuously, select the response based onassessment of the patient's shortness of breath while using oxygen.

If the patient uses oxygen intermittently, mark the response based onthe patient's shortness of breath WITHOUT the use of oxygen.

The response is based on the patient's actual use of oxygen in thehome, not on the physician's oxygen order.

For a chairfast or bedbound patient, evaluate the level of exertionrequired to produce shortness of breath. The chairfast patient can beassessed for level of dyspnea while performing ADLs or at rest.

OUTCOME MEASURE #6ACUTE CARE HOSPITALIZATION

This is scored on the TRANSFER OASIS If the patient was admitted to more than one facility, indicate the facility to which the patient was admitted

first (e.g. the facility type that they were transferred to from their home). When a patient dies in a hospital emergency department, the Transfer to an Inpatient Facility OASIS is

completed. In this unique situation, clinicians are directed to select Response 1 Hospital for M2410, eventhough the patient was not admitted to the inpatient facility.

Admission to a freestanding rehabilitation hospital, a certified distinct rehabilitation unit of a nursing home, ora distinct rehabilitation unit that is part of a short-stay acute hospital is considered a rehabilitation facilityadmission.

Admission to inpatient drug rehabilitation is considered an inpatient admission. Select "1 Hospital," whether itwas a freestanding drug rehabilitation unit or a distinct drug rehabilitation unit that is part of a short-stayacute hospital.

Admission to a skilled nursing facility (SNF), an intermediate care facility for the mentally retarded (ICF/MR), ora nursing facility (NF) is a nursing home admission

When completing a Transfer, select Response 1, 2, 3, or 4. NA should be omitted from this item for transfer. When completing a Discharge from agency not to an inpatient facility, select Response "NA."

COMPONENTS OF APATIENT SURVEY STARRATING

HHCAHPS

The Consumer Assessment of Healthcare Providersand Systems (CAHPS®) Home Health Care Survey,hereafter referred to as the "Home Health Care CAHPSSurvey" or "HHCAHPS", is designed to measure theexperiences of people receiving home health carefrom Medicare-certified home health agencies.

The HHCAHPS is conducted for home health agenciesby approved HHCAHPS Survey vendors.

CARE OF PATIENTSURVEY QUESTIONS

COMMUNICATIONS BETWEEN PROVIDERS& PATIENTSSURVEY QUESTIONS

SPECIFIC CARE ISSUESSURVEY QUESTIONS

SURVEY QUESTIONS FOR PATIENTS FROMINTAKE

Key Areas for Clinicians to Ask at Every Visit Do you feel we have treated you gently and with care? Do you feel the visits you have received have been on time or someone

has called you when they are late? Did we tell you what care and services you would get? Have we given you information that has been easy for you to

understand? Have you received information on how you can set up your home so

you can move around safely? Has someone ask to see and talked to you about all of your

medications? Did someone talk to you about the side effects of any new or changed

medications and when you should take those medications? Have we asked you questions each visit about your pain?