Risky Behavior? Ignoring OASIS Risk-Adjustment!

Risky Behavior? Ignoring OASIS Risk-Adjustment!

The same risk-adjustment calculations applied to CASPERs and Home Health Compare affect payment amounts in the Home Health Value Based Payment Demonstration (HHVBP) CMS is conducting in nine states, and plans to implement in some form nationwide.

This new twist makes risk adjustment even more vital to agency success.

Why don't scores on Home Health Compare match individual agency OBQI CASPER reports? How do Medicare Administrative Contractors calculate HHVBP payment amounts?

It's all in the risk adjustment.

In nutshell, when you examine your agency's CASPER reports, you see raw, patient-specific characteristics, outcomes, and process measures, as well as statistics that compare the agency's performance to state and national averages. In CASPERs, the nationwide and statewide data is "risk adjusted" to allow an apples-to-apples data comparison between your agency and others throughout your state and across the nation, regardless how your patients' diagnoses, service needs, functional abilities, and other clinical issues compare to those at other agencies.

At Home Health Compare, the opposite is true. Anyone searching Home Health Compare sees data with each agency's data "risk adjusted" to allow an apples-to-apples comparison with the raw data reflected in the statewide and nationwide scores. This applies to patient improvement outcome percentage scores as well as to 5-Star ratings.

CMS' OBQI User's Manual describe risk adjustment as "factoring out, or accounting for, differences in an agency's patients vs. the reference sample," to "level the playing field" between agencies.

CMS' intent for CASPERs, as described in user manuals (downloadable for free at the bottom of CMS' Quality Initiatives page) is to provide data to feed agencies' quality improvement performance improvement (QAPI) programs; to inform surveyors of potential agency issues regarding patient care, and to provide data to CMS for research on patient care quality and agency payment.

The Centers for Medicare and Medicaid Services (CMS) dedicate a page to explaining what risk adjustment is, and how it applies to OASIS data in publicly reported Home Health Compare scores vs. agency-specific outcome-based quality improvement (OBQI) outcome-based quality management (OBQM) reports, collectively known as Certification and survey provider enhanced reports (CASPER).

Watch for an education module on Home Health Risk Adjustment, coming soon to noyceconsulting.com.

Lisa Selman-Holman's blog post last week at Home Health Insight also provides valuable insight into home health risk adjustment.

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