Medicare Certification for Home Health Agencies (HHA)

Standardized Outcome and Assessment Information Set (OASIS)  for Home Health Care Certification Requirements Oasis-C2, SPADEs, and OASIS nutritional risk evaluation Future testing may include additional home health agency involvement and efforts to reduce burden of data collection

The refinement of efforts to evaluate patient experience and quality of care has continued through the leadership of the CMS. The CMS houses a site to store and disseminate policy and technical information as part of the Outcome and Assessment Information Set (known as OASIS), which is a data set for use in home health agencies, state agencies, software vendors, and other federal agencies charged with maintenance and implementation. To seek a home health agency Medicare certification, it is required to demonstrate that the agency meets the Medicare Conditions or Participation (CoP), which includes adherence to OASIS requirements.

In 2018 a report was issued on the 2016-2017 field test of draft standardized elements in surveys, including existing elements from the current OASIS-C2, a new nutritional risk item, and a sample of Standardized Patient Assessment Data Elements--identified by their acronym “SPADEs”. The field test included the following objectives:

-Update or establish reliability and validity of the items tested

-Test responsiveness and sensitivity of existing OASIS-C2 items to detect small, medium, and large effects

-Compare the subset of OASIS-C2 items with selected SPADEs for feasibility, reliability, and validity

-Explore feasibility and usability of SPADEs

-Explore feasibility of implementing a global health survey (PROMIS) in home care

Data collected included a detailed medical history and discharge assessment that was detailed for clinical evaluation and patient interview. Items included were pain, respiratory status, cardiac status, elimination status, neuro/emotional/behavior status, mental status, activities of daily living, medications, care management, and emergent care. The global health survey included six questions to rate health, quality of life, social activities, and others along with four items on the ability to carry out activities of daily living, emotional, fatigue, and pain items. The Patient Global Rating of Outcomes (PGRO) included seven items on activities of daily living, pain, and surgical outcome for a wound care patient. These items were evaluated for feasibility, reliability, and validity.

Most of the items from the subset of the OASIS-C2 and the SPADEs tested were deemed feasible and valid. A global health survey was also judged as feasible. However, it was clear that careful training before data collection, especially for new and unfamiliar items, will be essential to reduce limitations of the field test. Patient reported outcomes as a part of the global health survey were considered valuable and may be expanded to testing in non-English speaking patients. The authors of the field test report noted that including proxy and caregiver reports may be considered.

Lessons learned in this report shed light on what may happen in future testing to further refine and validate survey measures of patient satisfaction and experiences. These include the importance of including home health care agency personnel in the design process to improve successful and reliable survey implementation, and the importance of efforts to align with home health agency operations and the reduction of burden on patients and data collector activities.

Sample of WOCN Satisfaction Survey

This is a sample of the survey tool developed by the Wound, Ostomy Continence Nurses’ Society to measure patient satisfaction with their wound, ostomy, continence or foot care. It is a very short form designed to gauge patient feelings about how they feel overall about the care they received. Of note is that this form is intended to be filled out anonymously (but does include an area for the patient to fill in their name and address).

Sample of Respiratory Care Satisfaction Survey

Here is a sample of a respiratory care survey tool designed to gather responses to some very specific services provided by a home respiratory provider. This survey has nine question total, and is designed to be administered online. There are questions specific to the accuracy of the time equipment was delivered, the condition of those items, the home training on their use, as well as some questions about the thoroughness and consideration given the patient by the staff from the provider.