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Transforming Home Healthcare – 8 th Scope of Work . LT David Dietz Task 1b Government Task Leader [email protected] February 16 – Chester River Home Health and Hospice visit Meeting the needs of HHAs Structure/focus of visits Timeliness Processes/systems that fit their needs

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Transforming Home Healthcare – 8th Scope of Work

LT David Dietz

Task 1b Government Task Leader

[email protected]

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Transformational Change

  • Change which enables an HHA to deliver care meeting the goals of safety, effectiveness, efficiency, timeliness, patient-centeredness and equity

  • Results from the implementation of 4 strategies:

    • Measure and report performance

    • Adopt HIT and use it effectively

    • Redesign care process

    • Transform organizational culture

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Home Health Quality Improvement Priorities for 8th SoW - Possibly

  • Achieve specified reduction in failure rates for acute hospitalization (IPs and statewide)

  • Achieve specified reduction in failure rates for the publicly reported OASIS measures (IPs and statewide)

  • Achieve a specified improvement rate for immunization assessment (statewide)

  • Implement and utilize telehealth

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Effective Use of Resources

  • Maximize available resources (e.g., MedQIC, QIOSC, collaboration with other Task 1 sub-tasks)

  • Share resources within the QIO community – this is a national program, not a state one

  • Integrate communications and consistent program messages

  • Share learning and promote successes – this is a national program, not a state one

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Acute Care Hospitalization - Possibly

  • Based on 23% best attainable rate (75th percentile of 7th SoW Round 1 IPs)

  • 50% Reduction in failure rate for IPs (e.g., 27% - 25%)

  • 30% Reduction in failure rate for statewide

  • IPs must work with this measure

  • This is also a mandatory statewide measure

  • If a state has a rate less than or equal to 23%, they may develop their own plan for reducing acute care hospitalization (to be approved by PO and GTL)

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Publicly Reported OASIS Measures - Possibly

  • Target reduction in failure rates, based on 75th percentile of 7th SoW Round 1 IPs

  • Target reduction in failure rates based on 90% best attainable rate (100% for status of surgical wounds)

  • If the performance for the QIO’s state/jurisdiction for statewide work or IP work is greater than or equal to 90% (minus acute care and status of surgical wounds, the QIO shall work on a different measure)

  • IPs will work on one of their choosing; regarding the statewide, the QIO will choose the measure

  • Emergent care is excluded

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Statewide Immunization Work - Possibly

  • Goal: to incorporate influenza and pneumococcal immunizations into HHAs comprehensive patient assessments

  • Two surveys conducted – Sept 2006, the other measuring improvement, Nov 2007

  • Goal: to achieve a 50% improvement from baseline to remeasurement, measuring the percent of HHAs that have incorporated these immunizations into their comprehensive patient assessment, including offering these vaccinations as well as providing follow-up consultation if necessary

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Telehealth IP Specifics - Possibly

  • Implement or utilize telehealth as a tool to reduce acute care hospitalization

  • May include telemedicine (i.e., audio consultation, phone messages) or telemonitoring (i.e., audio/video/data consultation)

  • Shall meet CMS Telehomecare Clinical Guidelines (developed by Quality Insight of PA), to be released summer of 2005

  • Evaluation would include both an implementation and acute care hospitalization component (greater RFR than non-telehealth IPs)

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IP HHA Size Requirements - Possibly

  • HHA size based on OBQI reports

  • Small HHAs – less than 90 episodes annually

  • Medium HHAs – 91-350 episodes annually

  • Large HHAs – 351+ episodes annually

  • Minimum requirements:

    • 10% Small HHAs

    • 10% Medium HHAs

    • 15% Large HHAs

      *If a state/jurisdiction is unable to meet these requirements, it must demonstrate so to both the PO and GTL

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Substitution Clause - Possibly

  • The QIO may select up to 10 additional HHAs to work with on identified participant activities. The QIO may substitute 1 or more of these 10 HHAs at the time of evaluation only if a) an IP has gone out of business, or b) changed ownership (changes based on PRS )

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8th Scope of Work – QIOSC Competition

  • Scope of work is completed, request for proposals soon to follow

  • Open competition to all

  • Consider your resources before you submit a technical proposal……

  • Consider your reasons before you submit a technical proposal……

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The 4 QIO Commandments

  • We live and die by the numbers

  • We must constantly report quantitative estimates of our activities and accomplishments

  • We must demonstrate performance difference between identified participants and statewide

  • We must enjoy and like to do this!

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7th Scope of Work, Rounds 1 and 2

  • 36 Total states rounds 1 and 2

  • 22 States scored .95 or better

  • 14 States did not reach .95 !!!!

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How Do We Prove QIO Program is Effective?

  • Identified participant performance based on NUMBERS

  • Direct correlation between QIO efforts and positive improvement in the data

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How Do We Prove QIOs Are Efficient?

  • Shared resources developed by QIOSC

  • Less duplication in efforts

  • Shared learning = shared success stories

  • National improvement

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