New Calculations in Timely Initiation of Care
Timely initiation of care is one of the process measures that is reported on the Home Health Compare website and used in the calculation of star ratings. Because of this, it is important to understand which M items are used in the calculation of this measure and the recent changes that were made in this calculation.
First, let’s look at calculating this measure for SOC assessments. Four dates are referenced on the SOC assessment to determine if this process measure has been met – M0030, M0102, M0104 and M1005. If the patient has a specific physician-ordered SOC date, in other words, if there is a date recorded in M0102, the SOC date must be on or before this date to “get credit” for this process measure. If a physician-ordered SOC date was not given, then the referral date (M0104) and inpatient facility discharge date (M1005) are referenced. The SOC must be within 48 hours of the later of these two dates. There has been no change to the way this measure is calculated for start of care assessments.
Let’s take a look at this example:
Your home health agency receives a referral for a patient on Friday, April 13th, but the patient is not discharged until Saturday, April 14th. Because the hospital discharge date is later than the referral date, the agency has 48 hours from Saturday the 14th to see the patient.
What has changed is how we calculate this measure for resumption of care assessments. Prior to January 13th, 2018, the resumption of care date had to be within two days of the hospital discharge to “get credit” for this item. With the implementation of the new Conditions of Participation which took effect January 13th 2018 - physicians are allowed to specify a resumption of care date expanding the opportunity for agencies to meet this measure.
Let’s look at an example of this:
Your patient is discharged from the hospital on Friday, April 13th with an order from the MD to resume services on Monday the 16th. Even though the resumption of care date is greater than 48 hours after the hospital discharge, the agency will still “get credit” for this process measure by resuming care on the 16th.
Understanding how quality metrics are calculated, especially those that are publicly reported and those that impact star ratings is imperative.