Home Health Care CAHPS Survey Patricia Jump, MA, PHN, RN, COS-C President Training & Consulting www.acorns.com
What is CAHPS? Consumer Assessment of Healthcare Providers and Systems Survey to collect data from patients & consumers about experiences with care received Developed by the Agency for Healthcare Research and Quality (AHRQ) Goals of CAHPS Surveys Conduct survey in standardized manner Analyze & adjust data Publicly report survey results Survey results used By consumers to choose a health care provider By providers to improve quality of care To monitor performance of health care providers Survey Data Collection Survey conducted by independent survey vendors Provider has contract with approved vendor Sampling and data collection monthly Three modes of data collection allowed 1. Mail 2. Phone 3. Mixed-mode (mail with telephone follow-up of non-respondents) copyright Acorn's Inc. www.acorns.com 1
Survey = 34 items Questions about access to care & communication/interactions with agency staff Patients asked to rate agency & to indicate willingness to recommend agency Demographic items (health status, education, whether patient lives alone) Supplemental items Example Core Questions (1-25) Your Home Health Care When you first started getting home health care from this agency, did someone from this agency talk with you about how to set up your home so you can move around safely? Your Care From Home Health Providers in the Last 2 Months In the last 2 months of care, did you and a home health provider from this agency talk about pain? About You Items (26-34) In general, how would you rate your overall health? Do you live alone? What is the highest grade or level of school that you have completed? No changes are permitted to the Home Health Care CAHPS Survey core questions or to the About You questions copyright Acorn's Inc. www.acorns.com 2
Supplemental Questions Agencies may add own questions or use some or all of the Home Health Care CAHPS supplemental questions Supplemental questions: Must be placed after the core Home Health Care CAHPS Survey questions (Questions 1 25) May be placed either before or after the Home Health Care CAHPS Survey About You questions Do not need to be approved or reported to CMS HH-CAHPS Timelines Voluntary participation started Oct. 09 Final rule for Home Health Care Prospective Payment System (published in the Federal Register on November 10, 2009) delayed Implementation tied to reimbursement by six months Found on pages 58099 58104 - link: http://edocket.access.gpo.gov/2009/pdf/e9-26503.pdf Rule links survey requirements to CY 2012 payment update rather than CY 2011 payment update HHCAHPS will be requirement for agencies to receive full 2012 annual payment update 2% reduction in home health market basket percentage for failure to report required quality data HH-CAHPS Timelines Required to participate in dry run at least one month during July, August, and/or September 2010 Dry run can be for any month during third quarter 2010 and can be for 1, 2, or 3 months National implementation begins October 2010 Continuously collect survey data beginning in fourth quarter 2010 and moving forward Data collected during the voluntary phase between October 2009 and June 2010 will be publicly reported copyright Acorn's Inc. www.acorns.com 3
Survey Inclusions Patient eligibility Update: only patients whose home health care is paid by Medicare and Medicaid will be included Traditional Medicare and Medicaid programs Medicare Advantage (MA) health plan MA preferred provider organization (PPO) Medicare private fee-for-service (PFFS) plan Medicaid managed care plan for home health care May use survey for all patient groups, but survey data would not be reported to CMS vendors can exclude this group as part of the data processing Survey Exclusions Private health insurance, Department of Veterans Affairs, TRICARE, etc. Agencies may conduct the survey for these payers but data would not be reported to CMS Patients under age 18 Patients who did not have at least one visit for SN,OT, PT, SLP during sample month and two visits during lookback period Lookback period is sample month & month immediately preceding sample month Survey Exclusions (cont) Deceased patients Patients currently receiving hospice care Routine maternity care only Patients who requested agency to not release their name Patients who have not been included in the survey sample in the past 5 months copyright Acorn's Inc. www.acorns.com 4
Samples Requirements Minimum of 300 completed surveys over 12-months (average 25 per month) Nov. 09 Update: CMS initially proposed requirement to collect be waived for agencies that serve fewer than 60 eligible patients annually CMS kept this provision in the Final Rule but CMS states in the Final Rule that by June 16, 2010, home health agencies need to provide CMS with patient counts for the period of April 1, 2009 through March 31, 2010 This requirement pertains only to Medicare-certified agencies with fewer than 60 eligible, unduplicated Medicare or Medicaid patients for that time period Such home health agencies would be exempt from conducting the HHCAHPS Survey for the annual payment update in CY 2012 Home health agencies that have fewer than 60 eligible, unduplicated Medicare and/or Medicaid patients would be exempt from data collection from third quarter CY 2010 through second quarter CY 2011 More information about how small agencies can apply for an exemption from participating in HHCAHPS will be posted on https://homehealthcahps.org in February 2010 Getting Started Designate a staff member as Survey Administrator for the Home Health Care CAHPS Survey Contract with approved Home Health Care CAHPS Survey vendor List @ https://homehealthcahps.org Can change vendors at beginning of quarter Complete the online User Registration Form Complete and submit the Home Health Care CAHPS Survey Consent Form Compile/deliver to vendor each month a file with information about patients served or discharged during the sample month Include patients from all units and branches filing under same CMS Certification Number Monitor survey vendor data submissions Preview public reporting results Vendor Approval Select vendor from list of approved vendors [see MHCA vendor list] Select start date (date on which vendor can begin work on your behalf) Recommend leaving the end date blank Select Mode(s) for which the vendor will be authorized Click on submit form button copyright Acorn's Inc. www.acorns.com 5
Vendor Approval Data Submission Summary Report for Agencies Allows agency to monitor data submission activity Lists dates for which vendor has submitted data Can click on date to view details of Data Upload Summary Report for a given uploaded file Survey Administrator Role Register online as agency Survey Administrator Designate another staff member as a Backup Administrator Complete and/or approve each staff person within the agency who will have access to the private section of the website (referred to as non-administrator user) Grant non-administrator users access to specific functions on the website Update non-administrator user information Remove access and/or approve removal of access for users no longer authorized to access the private links. Serve as main point of contact with the Data Center. copyright Acorn's Inc. www.acorns.com 6
Provide to Vendor Source of payment Primary & other diagnosis V codes now accepted as diagnoses codes on monthly patient information file submitted to vendor Activities of Daily Living (ADLs) Total count of all patients served during sample month May submit on a second file after survey is initiated Public Reporting Publicly reported results will be based on 12 months (four quarters) of data Results updated each quarter Agencies provided preview of data each quarter before reported on Home Health Compare CMS will use composite measures and global ratings of care Measures Composite Measures 1. Care of Patients 2. Communications Between Providers and Patients 3. Specific Care Issues (medications, home safety, and pain) Global Ratings 1. Overall Rating of Care Given by Providers 2. Patient Willingness to Recommend the Agency to Family/Friends copyright Acorn's Inc. www.acorns.com 7
Survey Information Protected by Federal Privacy Act of 1974 Not part of Do-Not-Call list designed to stop sales and telemarketing calls Survey takes on average about 12 minutes to complete more if other questions added No part of member s name, date of birth, telephone number, SSN, service dates, or home health agency CMS Certification Number (CCN) may be used Codes Available to Vendors 210 Ineligible: Deceased 220 Ineligible: Does not meet survey eligibility criteria 230 Ineligible: Language Barrier 240 Ineligible: Mentally or Physically Incapacitated Determined during the course of data collection Used only when there is no proxy respondent Includes visually impaired for mail-only mode Includes hearing impaired for phone-only mode Includes mental and physical impairments for all applicable modes Codes Available to Vendors 310 Nonresponse: Break-off Assigned when less than 50% of survey is completed 320 Nonresponse: Refusal Client indicates in writing or verbally that he or she does not wish to participate. 330 Bad address/undeliverable mail 340 Nonresponse: Wrong, disconnected, or no telephone number 350 No response after maximum attempts For Mail-Only Mode Assign if address is viable but there is no response to the mail survey For Phone-Only Mode Assign if telephone number is viable but minimum number of call attempts (five) does not result in a completed interview copyright Acorn's Inc. www.acorns.com 8
HHCAHPS Survey Website https://homehealthcahps.org Links Available to Public Private Links copyright Acorn's Inc. www.acorns.com 9
Ongoing Activity CMS will conduct a separate Mode Experiment survey to estimate the effects of survey mode and patient characteristics on survey responses Results from the mode experiment will be used to adjust the results of data collected in the national implementation if differences are detected Resources (www.acorns.com) OASIS DVD OASIS-C Webcast Boundaries Video (~15 minutes) Recruitment and Retention (Seminars, Video, Audiotapes) HIPAA Training (Seminars, Videos, Study Guides) HIPAA Privacy Primer Video (~12 minutes) HIPAA Privacy Training for Frontline Worker Video (~ 1 hour) Home Care Policy/Procedure Manual Medicare Home Care Mock Survey OASIS Focused Audit Tool Medicare Documentation Training Manual Mentorship Implementation Manual Seminars and Keynote Speaking Email: PatriciaJump@Acorns.com 507.533.6204 copyright Acorn's Inc. www.acorns.com 10