Special Notice About How the Hospitalization Rate is Determined

There will be a significant change next quarter in the way the home health hospitalization rate is calculated for reporting on Home Health Compare (HHC). Effective with the January 2013 HHC data update, the hospitalization rate will be calculated using Medicare claims instead of using OASIS data.

Here are key changes regarding the claims-based measure:

  • Claims-based measure uses Medicare claims data as the data source instead of OASIS.
  • Claims-based measure is based on the Start of Care (SOC) date instead of the transfer/discharge date.
  • Claims-based measure has a fixed timeframe of 60 days instead of the quality episode. Hospitalizations that occur in the 60 days following a SOC will be counted regardless of whether or not the patient was discharged from the home health agency.
  • The claims measure numerator is the number of home health stays with a claim for hospitalization. Stays are essentially 60 day payment episodes.
  • The claims measure denominator is the number of all home health stays.
  • Claims-based measure applies to Medicare FFS patients only while the OASIS-based measure is applied to Medicare FFS, Medicare Advantage, and Medicaid patients.
  • LUPAs are excluded from claims-based measure.
  • Observation stays in the hospital that begin in the emergency room are not included in an agency’s hospitalization rate but will be included in the agency’s Emergency Department Use without hospitalization rate. The ED use measure is also claims-based.

Click here to download Claims-Based Utilization Measures Specifications from the CMS HH Quality Initiative/OASIS web site.

Given the significant difference in the two data sources, the results from the claims-based measure will not be comparable to the OASIS-based measure results. However, an agency’s CASPER reports currently include the claims-based rate as well as the OASIS-based rate in individual reports. The OASIS-based result will continue to be reported on the CASPER Reporting System. Authorized Agency staff can access CASPER using their log-in credentials to the CMS OASIS System.

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