This article is in reference to the metric "Average Days from Facility Discharge to 1st HHA Visit." The metric can be found on the Home Health Detail page in the table; "Home Health Agency Quality Metrics."
As a condition of participation, home health agencies must conduct an initial assessment visit within 48 hours of receiving a patient referral (unless the referring physician specifies a different date for the start of care.) At this time, Excel Health does not have access to the referral dates, so we are unable to reference this date in the calculation of any metrics. As a result, for this number, we determine the difference, in days, between the discharge date from the previous facility and the first visit provided by the admitting agency. Because the referral date is not reference, this metric should not be construed as an indicator of timely vs. untimely start of care for the HHA. Nevertheless, the metric is helpful in assessing the agencies performance overall.
About the Metric
The metric is the average of all home health Medicare patients admitted to the home health agency on the page with the following limitations
- To get the counts that contribute to the calculation, we "subtract" the discharge date from the admission date. For example, it a patient is discharged on October 5th and admitted on October 10, the difference is 5 days. You can consider that we only count either the discharge date or the admission date.
- The count is not limited to hospitals; we count any facility that discharges patients coded for home health post acute care.
- We only count claims that indicate a status of discharged to home care. (06 in box 17)
Comparing this Metric to 48 Hour Timeliness
For obvious reasons, a home health agency will be careful to give heavy consideration to this metric because of the 48 hour rule. However, here are some considerations to remember when looking at this metric. These provide a measure of insight into why the Excel Health numbers are higher than what a home health agency would expect.
- Referral Dates - Remember that the HHA has 48 hours from the referral to provide the initial visit. Since we don't have access to the dates of home health referral, we use the prior discharge instead. Quite often the referral isn't made until a period of time has passed. This will add days to the counts before the 48 hour period even begins.
- Hold that Visit! - In addition, even after a referral is made, the patient might hold off the first visit for any number of reasons. Although the 48 hour rule allows an HHA to document this so as to satisfy the condition of participation, that extra time is still added to the count in our metric.
- 280 Reasons to Wait - There are about 280 DRG's for which, if post-acute care is initiated within 3 days, there is a change in reimbursement to the discharging hospital, and this change is generally down. In these cases, a hospital might "hold off" on presenting a referral to home care. Once again, this is not penalized against the home health agency that can still meet the 48 hour requirement, but these extra days could effect the metric upward.
- TGIF - Most patient discharges happen on Friday. Even if a referral occurs immediately, many patients will not want to be seen on the weekend. This will again bump up the average between discharge and first visit.
If we take into consideration the factors mentioned above, we can make some useful observations:
- Any HHA that has a metric in this table between 2-3 days is probably doing a fantastic job of getting out to their first visits well within the required 48 hours from referral.
- If you find an agency that is really close to the 2 day average, there is a high probability the agency is working closely with the discharge planning team at the source facilities.
- In light of the high discharge volume on Fridays, this metric should be used in close association with the metric a few columns to the right, "Percent of HHA Episodes started on a Weekend." Any agency that has a low number getting out to the first visit will invariably be working the weekends hard.