Medicare Home Health Agencies: Weaknesses in Federal and State Oversight Mask Potential Quality Issues
Home health agencies (HHA) play an important role in the U.S. health care system -- allowing individuals who are unable to leave home without great difficulty to receive certain medical or therapeutic care in their own homes. In 2000, Medicare covered home health services for 2.5 million people at a cost of $8.7 bill. This report assesses quality-related aspects of HHAs. Covers these questions: (1) what is known about the quality of care provided by HHAs, (2) is the current survey process adequate to identify quality-of-care problems at both parent & branch offices, (3) are state investigations of complaints made against HHAs effective in protecting patients, & (4) is Fed. oversight of state survey activities & enforcement efforts adequate? Tables.
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80 HHA Surveys active HHAs admitted to home adverse events alleged Appendix assess August 17 branch offices Centers for Medicare cited deficiencies CMS regional offices CMS requirements CMS's complaint investigations compliance Connecticut COP deficiencies COP-level deficiencies current survey deficiencies cited determine ensure entered into OSCAR evaluate filed Florida HCFA HHA surveyors HHA's HHAs with COP-level home health aide identified immediate and serious implemented infection intermediate sanctions Investigation Time Frames Kansas licensed practical nurse Louisiana Massachusetts Medicaid Medicaid Services medical records Medicare COPs notify physician number of HHAs nursing home survey OASIS data OSCAR data outcome oversight patient harm patient visits patient's condition physical therapy potential pressure sores prospective payment system provided by HHA quality-of-care problems record review registered nurse serious threat skilled nursing services standard survey supervision survey activities survey agency survey and certification survey process survey results termination Texas toll-free telephone unduplicated wound
Page 91 - HHA's OSCAR termination code is "Voluntary—risk of involuntary termination." Source: Documentation provided by and discussions with Texas state agency and CMS Dallas Regional Office. Appendix IX: Comments from the Centers for Medicare and Medicaid Services DEPARTMENT OF HEALTH & HUMAN SERVICES DATE: TO: FROM:
Page 6 - To qualify for services, beneficiaries must be confined to their homes; have a plan of care signed by a physician; and need intermittent skilled nursing care (other than solely venipuncture for the purpose of obtaining a blood sample), physical therapy, speechlanguage pathology services, or have a continuing need for occupational therapy services.
Page 2 - General Accounting Office, Medicare Home Health Agencies: Certification Process Ineffective in Excluding Problem Agencies, GAO/HEHS-98-29 (Washington, DC: Dec. 16, 1997). 4 Medicare,
Page 82 - professional standards: agency staff must comply with accepted professional standards and principles that apply to professionals furnishing services in an agency. Duties of RN: regularly
Page 2 - and SCHIP Benefits Improvement and Protection Act of 2000, Pub. L. No. 106-554, Appendix F, § 506,114 Stat. 2763A-463, 2763A-531.
Page 93 - Recommendations To strengthen the ability of the HHA survey process to identify and address problems that affect the quality of care.
Page 7 - HHAs were paid on the basis of their costs, up to preestablished per-visit limits.
Page 81 - Likely patient harm Patient was admitted to the hospital and died. The state surveyor said that "there was no coordination between the nurse, clinical supervisor, physician, and medical insurer agency ... to ensure that this client received the ordered laboratory tests for monitoring the prothrombin levels . . ." that would have prevented the patient's hospitalization and subsequent death.
Page 59 - survey results had not been entered into OSCAR, the HHA had been terminated, the HHA was deemed by other entities to meet Medicare COPs, or the HHA only served Medicaid recipients (66 of 6,905 HHAs in OSCAR as of August 17, 2001). No survey results would be expected or required in the last three instances.