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CHICAGO - Responding to concerns that Americans lack critical information when choosing home health-care services, the federal government Monday began publishing data comparing the quality of the nation's 7,000 home-care providers.
The reports measure how effectively home health agencies provide care to patients in need of short-term help with essential daily activities - comparing everything from dispensing medicines correctly to getting patients out of bed or bathed.
Top health officials in the Bush administration say the quality comparisons may be more important than nursing home numbers released last year.
Because home-care helps seniors and the disabled stay at home - and delay or avoid more expensive institutionalized care such as a nursing home - it is better for patients and less expensive for the federal and state governments, proponents say. The government Medicare and Medicaid programs spend more than $17 billion annually on home health care.
"Not only will consumers be better informed, but home health agencies themselves will be able to see more clearly what they must do to improve their care," Health and Human Services Secretary Tommy Thompson said. "Publishing this kind of information creates real incentives for health-care providers to further improve the quality of care that they provide to their patients."
While the government routinely collects information on home-care providers, comparative numbers have not been readily available to consumers.
State and federal inspectors have the clout to shut down home-care providers for fraud or other violations. But government health officials acknowledge that their efforts have come up short when it comes to providing consumer-friendly ways to help the public make informed choices.
Those who will benefit from the information include people like 83-year-old Helen Heyrman, who is caring for her 89-year-old sister, Nina Moore, in the three-bedroom Evanston, Ill., condo she shares with her husband. She said she may one day need to look for home care.
"A lot of people don't know about home health agencies and what is good or not," Heyrman said. "Home health is what most people want because it is cheaper. A lot of people don't know where to start."
There are more than 3.5 million Americans in need of home-care every year, according to the government. Those numbers are expected to grow as Baby Boomers enter their retirement years.
Home-health providers "will have a market-driven incentive to improve the quality of care," Thompson said. "These measures will help them maintain and improve quality of care. They will be rewarded with positive data and, I am sure, more business."
The home-care industry applauded the government's quality initiative but said consumers should only use the data as one tool in choosing a home-care provider or agency.
"They should talk to their physicians, hospital-discharge planners and look to see if (a provider) is accredited by an independent body," said Tom Galluppi, president of Illinois Home Care Council and director of finance for Chicago-based Resurrection Home Health Services. "I don't know if (the government report) would weed out the bad apples, but it is one tool that you can use to identify good providers."
The report compares providers to a state and national average.
Illinois agencies generally met or exceeded the national average of scores in 11 categories. In three measures, it was one percentage point below the national average.
For example, 56 percent of patients in Illinois home health agencies, on average, got better at bathing, compared with the 57 percent national average. Meanwhile, 38 percent of patients using Illinois home health agencies improved their abilities to take medication correctly, compared with 35 percent nationally.
Home health agencies in Massachusetts, Texas and Wisconsin generally performed below the national average.
Comparisons of all Medicare-certified facilities are available on the government's Medicare Web site at http://www.medicare.gov, or through the help line, 1-800-MEDICARE.
Still, critics of the government's performance initiative wondered how meaningful the measures and comparisons would be if there were no punitive measures for providers that didn't score well.
"This leaves the consumer in the position of being the health-care police," said Gail Siegel, executive director of the Coalition for Consumer Rights, a Chicago-based advocacy group. "We need to know that home health agencies that fall below a certain mark will have to face a certain kind of consequence. The information is just left hanging there, and that doesn't inspire a great deal of confidence."
But the federal government eventually wants to tie Medicare reimbursement to quality measures, which will be designed to work as an incentive to improve quality of home health service.
The government has not determined when quality measures will be tied to reimbursement, but officials say it is coming. In the private health insurance market, managed-care plans negotiate pay-for-performance measures into their contracts with doctors and hospitals.
"It's a no-brainer, but this is not something people are used to from the government," said Thomas Scully, administrator for the Centers for Medicare & Medicaid Services, which is running the government's health quality initiative. "You can't pay people differentially until you get performance measures published. We are going to keep pushing and pushing and pushing."
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(c) 2003, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.
