Performance Improvement 2003. Office of Clinical Standards and Quality

01/01/2003

A Normative Standards Framework For Home Health Agency Performance Enhancement

This study explored the possible further development and testing of a normative standards approach through the Peer Review Organization (PRO) program in conjunction with the Home Health PRO Pilot Project. Normative standards were developed to assist Medicare Fiscal Intermediaries in making home health care payment denials under the Medicare cost-based payment. With the shift to the Prospective Payment System (PPS) for Medicare home health care in October 2000, normative standards were envisaged as a potential aid in identifying possible under-provision of services in a prospective payment environment. During the same period that the payment system was moving toward PPS, plans for the national implementation of outcome reporting and outcome-based quality improvement (OBQI) also were underway. As OBQI and PPS evolve, a promising role for normative standards is as a tool to assist providers and others to improve patient outcomes and the efficiency with which care is delivered. This report presented the normative standards approach developed to date and proposed for further testing. The essence of the proposed approach was to classify agencies into utilization and outcome categories and then tailor performance enhancement on already-developed home health outcome measurement, outcome reporting, and OBQI methods by enabling agencies to incorporate utilization information into their performance improvement activities.

FEDERAL CONTACT: Tricia L. Rodgers 410-786-1833 PIC ID: 7175

PERFORMER: Center for Health Policy Research, Denver, CO

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