Home Health Care CAHPS Survey

CAHPS Survey

Patricia Jump, MA, PHN, RN, COS-C

President

Acorn’s End Training &

Consulting

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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)

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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

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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)

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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

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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?

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“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?

Care CAHPS Survey core questions or to the “About You” questions

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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

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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

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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

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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

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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 underage 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

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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

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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

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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

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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

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Vendor Approval

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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

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Survey Administrator Role

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.

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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

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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

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Measures

•

Composite Measures

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

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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

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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

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Codes Available to Vendors

– 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

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HHCAHPS Survey Website

https://homehealthcahps.org

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Links Available to Public

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Private Links

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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

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Acorn’s End Resources (www.AcornsEnd.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@AcornsEnd.com 507.533.6204