Choices in Home Care

Vol. 18 •Issue 27 • Page 16
Choices in Home Care

New Performance Standards Help Consumers Decide Which Home Care Companies Measure Up

Among its other attributes, the Internet enables consumers to learn more than they ever could before about a product or service of interest to them prior to laying down their hard-earned cash.

In particular, the online universe empowers people with medical conditions to compare health care services they purchase from acute care hospitals.

So the day seemed inevitable when the more than 4 million Americans who receive home health services in some form could judge the quality of their home care providers by looking them up on their computers.

That day arrived in September when the Washington, D.C.-based National Quality Forum (NQF) published a set of 10 national performance measures for home care companies at the behest of the Centers for Medicare and Medicaid Services (CMS). Those standards can be found on the Web at

The primary purpose of these NQF-endorsed voluntary consensus standards is “to help consumers select high-quality home health care providers,” according to NQF President Kenneth Kizer, MD, MPH.

By helping consumers compare home care providers on the quality of their services, NQF hopes to improve the care given by the nation’s approximately 20,000 home care agencies. “Increasingly, the health care community is recognizing the benefit of standardized performance measurement and public reporting,” Kizer said.

Legal Standing

The National Quality Forum is a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.

“We are not an agency to which health care organizations report,” explained Philip Dunn, vice president of NQF’s Communications and Public Affairs. “NQF’s role is to standardize performance measures via a formal consensus development process that convenes a broad array of more than 300 health care stakeholder organizations, including consumers, purchasers, providers and researchers, in a manner resembling the federal rulemaking process.

“Because of the open, transparent nature of the process and the array of constituencies that participate, NQF’s endorsed measures have special legal status as voluntary consensus standards, meaning that if the federal government wishes to impose standards in any area and voluntary consensus standards exist, the government must use the consensus standards or else explain why it cannot.”

CMS has begun reporting data given voluntarily from thousands of Medicare-certified home care agencies reporting on the 10 measures. This information is found on CMS’s Home Health Compare Web site (

Examples of Measures

Measures on which consumers can now judge participating home care companies include:

Improvement in ambulation/locomotion.

Improvement in transferring.

Improvement in pain interfering with activity.

Improvement in management of oral medications.

• Improvement in dyspnea.

This is of special interest to readers here. A home health nurse or therapist should teach patients ways to minimize or avoid dyspnea, according to CMS, including breathing exercises, positioning oneself to breathe easier and relax, using several pillows when sleeping, taking rest periods between activities, and using a humidifier in winter.


Quality improvement organizations in every state (also contracted by CMS) will work with home care providers to improve services in the 10 measures, according to a CMS spokesperson.

Eventually, CMS officials may move toward a pay-for-performance reimbursement system, she said. Home care companies with good performance would receive a higher reimbursement than those performing not as well. But this is several years off. “Also, we’ll look at some process measures. Did the agency provide patients with flu shots, for instance,” she said.

Although voluntary, the measures may prove compulsory in an indirect way. Over time, consumers may view failure to volunteer information as suspect and infer that a home care company refusing to participate has something to hide, shortcomings to conceal. “It’s very interesting what consumers believe,” the CMS spokesperson said. “That could be a possibility.” For instance, she said, consumers don’t like it when a company posts on the CMS Web site that it has too few instances to report about a particular measure.

Since the process is so new, little is yet available formally on how consumers are taking to the home care measures. But the CMS spokesperson told ADVANCE she has friends who are grateful to have access to the information as they decide on nursing homes or home care agencies for loved ones.

“It seems the baby boomers are more computer literate and pay more attention to it,” she said. “Their parents are not there yet.”

You can reach Michael Gibbons at [email protected].