A quality episode is a component of building a measure of quality of home health near Okeechobee FL. Quality episodes are used in both measures of the process (how good health is at home). In the case of quality measures based on data collected from the OASIS Home Health Care Quality Notification Program (HHQRP), a quality episode is a component of developing a measure of quality of Home Care near Okeechobee FL. Quality episodes are used both in process measures (the effectiveness with which Home Care agencies use specific evidence-based care processes) and in outcome measures (the outcomes of healthcare experienced by patients)).Episode management is a continuous and proactive episode review process that consists of an ongoing weekly analysis of open Home Care episodes. Key components include risk assessments, objectives of care, analysis of the use of visits, the use of disciplinary measures, the accuracy of OASIS, and care plans.
According to CMS, in the PDGM, the first 30-day episode is early. All subsequent periods in the sequence are classified as late until there is an interval of at least 60 days between discharge and the start of care for the next episode. If 60 days have passed between episodes, the first 30 days of that onset of care are considered early and subsequent sequences and episodes are considered late. Keep in mind that this is automatically corrected in the claim, so agencies can't change late to early for an additional refund.
Home health measures not included in the HH QRP Measures related to potentially avoidable events (PAE) are a subset of outcome measures that are derived from OASIS data, but are not part of the HH QRP. The PAE measures were developed as part of the results-based quality improvement (OBQI) initiative that preceded the QRP of HH. PAE measures don't appear in Care Compare, but are available to HHAs through IQIES reports. Potentially avoidable events serve as markers of potential health care problems due to their negative nature and relatively low frequency.
Reported potentially avoidable events are outcome measures, in the sense that they represent a change in health status between the start or resumption of care and discharge or transfer to an inpatient facility. For a list of health measures that could be avoided, see the home health PAE measurement chart, which can be found at the link to the home health measurement tables in the download section below. Technical documentation for calculating potentially avoidable health measures can be accessed through the link to the technical documentation for Oasis-based measures in the download section below. The download section also has a link to the Results-Based Quality Monitoring Manual, which contains additional information on PAE measures. The doctor re-certified the patient for a new 60-day episode for continuous care of the wound caused by an abscess in the buttock.
When reviewing an episode of care, it was observed that the frequency of a patient's skilled nursing (SN) visits was greater than would be expected considering the primary diagnosis and the reason for the care. Prometheus Payment has performed this type of analysis to analyze several conditions of a national business population and has found that 40% of the costs of the episodes, on average, were allocated to services classified as “potentially avoidable complications””. The recommendations presented here serve as a starting point for a stronger agenda for testing the applications of care episodes. For these reasons, episodic approaches to chronic disease care should be evaluated in conjunction with patient-based approaches.
Providers responsible for episodes of chronic diseases would assume responsibility for treating patients on an outpatient basis and avoiding hospitalization to the extent possible. Specific applications of the episodes being discussed include profiling providers to provide comparative feedback to improve quality, public reporting, compensation for performance and “combined payments” by service group. Table 2 shows the distribution of allowed visits and total episode charges during 1986 for these HHA Medicare customers. A series of recent health system reform proposals have called for the use of care episodes as a basis for payment and performance measurement.
The process measures are derived from data collected in the OASIS submitted by home health care agencies and are calculated using a complete quality episode that begins with a home health care SOC to a home health agency (or with the resumption of care after a stay in a hospital) and ends with discharge, transfer to an inpatient facility or, in some cases, death. For nearly three-quarters of the conditionally eligible clients (72 percent; n = 2,615 unweighted customers), the start date of the episode so defined was identical to the “start date” of HCFA Form 485; and for another 7 percent (n = 25 unweighted), the start date of the episode was within 5 days of the date “from the date” of Form HCFA 485. The CV ranged from 72 for episodes related to a hip fracture, indicating lower variability, for diabetes-related episodes, indicating great variability within episodes of the same type of condition. The most recent proposals, which emphasize creating shared responsibilities for quality and cost among the broadest set of providers involved in patient care, call for the development of responsible care organizations (ACO) 19 or responsible care systems (ACS), 20: groups of providers who would assume responsibility for episodes or patients. Therefore, for this analysis, the conceptual definition of a new episode was that the client had not been receiving HHA services for the previous 60 days.
