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All righty. As Brigitte, said we're in the home stretch. First of all I think you all deserve a medal. It's quarter to 4:00. It's been a very long day and you're all still here. So either you accidentally sat in Gorilla Glue or you really, really do want to hear about how we're going to use the Quality Reporting Program Reports. And I'm hoping that that's the real reason. Because I know that there have been people over the different times that we've done presentations that have asked us if we could just go through them, show us where to find them, tell us what they mean and then let us play through a scenario so that we can actually understand what it is we're doing. And we took that to heart. And hopefully you'll get something out of this. So I know you're tired. But shake your hands, wiggle around a little. Let's get as prepared as we possibly can at this time of day. And I will try not to hold you too long, but to give you enough information so that we can do our little Case Study at the end and hopefully there something of value in this for all of you. So off we go. As we always do, the first two or three slides are going to give you all the acronyms that we use during this presentation. And that's your dictionary that you will have to use as we go through this and after you take these slides home with you. Our objectives at this final session are to describe the Quality Reporting Reports that you've been looking at, I hope. We're going to talk about how each report may be helpful to you in planning and conducting your quality improvement activities. We can look at how to obtain these reports in the CASPER system and then how you will utilize these same reports to perform a quality improvement analysis and a plan to act on it. Because doing the analysis isn't really going to help us, is it, if we don't make a plan, an Action Plan, as we've talked about at the end of every session today, an Action Plan to move forward. So let's take a look at this graphic here of an overview of the public reporting. When we look at this you can see that you have reports that are confidential and reports that are available to the public. Most notably we all know about Home Health Compare. But there are also the reports that are confidential, the ones that you look at, the ones that are going to help you to make decisions. The Review and Correct Reports, the Quality Measure Reports, and the Provider Preview Reports. And we are going to look at these one by one and just give you an overview so you'll have an understanding of what they can do for you. CASPER Reports can actually be divided into two groups. They are on-demand reports. This includes the Review and Correct Reports and the Quality Measure Reports that exist both at the agency level, but also at the patient level. And this is where you're going to do your best gold mining and digging around to find out exactly what's going on. Then there are the Shared Folder Distributed Reports. These are provider previews so you can see what's coming and the QAO Reports. Come on now. I think the clicker's tired too. The Review and Correct Reports, these are user-requested, on-demand. They're confidential to you. They provide agency-level quarterly and cumulative performance rates for your outcome and assessment information set OASIS-based reporting quality measures. So we've talked about these measures all day. But this is where you're going to have an opportunity to look at your performance rates. This gives you aggregate performance. What does that mean? It's being brought together so that you can look at the most recent four quarters as the data is available to you. You can also have updated data weekly. You can go in and run this on a weekly basis until the data correction deadline freezes. You're only going to have raw data. The risk-adjusted rates are not being shown. Excuse me one minute. I have this nice person who brought me fuel. It would never work if your presenter was the one who fell asleep and you were all sitting there looking at me, now would it? (Laughter) Okay. When we looked at these in the past we talked about the Provider Preview Reports. And you know that based on the calendar year data collection quarter that there are deadlines for when you are going to be able to submit corrections in order to impact the final product. This graph is showing you those time periods and the deadlines so that you will know when they are there and you'll be able to meet those deadlines. The data correction deadlines are for data that are used to calculate the publicly reported measures. And they're not applied to Confidential QM Reports. As of April 1, 2019 coming right up, and this is not an April Fools, there will be an addition of a patient-level data table. This is going to supplement agency-level data so that now you'll be able to go in and look at the Tally Reports, look at patient-level information on a measure to see where the patient triggered and where they did not. This will give you the ability to sort out patient-level data by patient last name, first name, discharge date and admission date. And you'll be able to request this individual report by the individual quality measure. That's very important. It's very critical to the QAPI plans that you're creating. You need to know where you were so that you will later know where you ended up. This is what the report is going to look like. So what you have here, you're going to see the highlighted yellow areas. You have the quality measures and you have the legend which is going to tell you how to read this information so that you will know, did this not apply to this patient? Did they trigger the measure or not? And you will be able to select the individual quality measure as I said that you want to see. Here you can see a blow up of the codes so that you can identify them when you're looking at the actual patient-level data report. Let's talk a little more about the Quality Measure Reports themselves. These are user-requested, on-demand CASPER Reports. What does that mean? It means that it's not a fixed setup of a fixed time period. You are able to go in and to say I want to look at this measure from this time period to this time period. It gives you process and outcome quality measure result data at the patient and the agency level as we have said. It's going to give you confidential feedback to the agency on your performance in that quality measure. And as I have said, this is critical in setting up and monitoring the progress of your Performance Improvement Plans as a part of your overall QAPI program. This will give you risk-adjusted data where that's applicable. And it will include all the data submitted from OASIS assessments with a target date that falls inside the requested reporting period. The target date is within the period regardless of the submission date. This does include claims-based measure data at the agency level. It's a snapshot of your performance for quality improvement purposes based on the data that you submitted and risk-adjusted where that applies. This can be used and used effectively for home health agency internal quality improvement purposes such as your quality assurance and performance improvement projects. This is very important. These reports are going to be critical to everything that you do. And so I strongly urge you as we go through this to utilize these resources and to get comfortable with going through the process of accessing them and reading them. The on-demand quality management reports as we said break down into two groups. You have agency-level reports. This includes your patient related characteristics which is really a thumbnail of what does your caseload look like. I'm going to talk a little bit more about this one because I find this to be extremely useful for an agency to hold a mirror up to themselves. The Outcome Report, the Potentially Avoidable Events Report. This one is like a report card of oops, and you really do need to look at where the oops occurred because you want to analyze it and find out if it was preventable and how you could have stopped it. And lastly in the agency-level you'll have the Process Measures Report. At the patient level, you can get that thumbnail picture of your agency as a whole. You can now break that down so that if on the -- we were going to look at this report in a little more detail. But an example would be if this report is telling you that the average age of your patients is 72, and you're thinking, that doesn't make any sense. Why yesterday I looked at two records were the patient was over 100 years old. One of two things, either you are just retaining an impression of more of the really older clientele as opposed to the younger ones, or you may want to check the accuracy of the data. And the patient-level data, even the Patient Characteristics Report will give you the answers to your questions. The Outcome Tally Report, at the patient level, how did each individual patient do on each individual outcome measure? Did it not apply to them? Did they trigger the measure or not? With potentially avoidable adverse events at the patient level, you are now going to know more than the patient who was discharged with a wound that never improved. All of these avoidable events you can now look at them at the patient level and know that my goodness that patient showed up in every single report for the last three quarters with multiple falls. Hmm, these are the things that you can pick up from these kinds of reports. And lastly the process tally is going to give you at the patient level how your patients did on each of the process measures. This is what the report looks like. Just out of curiosity, how many of you have run this and looked at it? Recently? Okay. That's not a lot of hands. I would hope that if I ask this question of you 30 days from now after you've had a chance to think about this material, log into CASPER that we'd have maybe three quarters of the room. Because this report has very valuable information. This is what it looks like, as I said. You have your agency information at the top. And I mentioned that it's at the top of every single report. I have spoken with agencies who dutifully notified of change of their address, other changes that were made in their agency demographic information at the top, they sent it in only to discover that the postal service failed to deliver and CMS doesn't know that they moved. You really do want to check this information on a regular basis to make sure that the correct information is in the system. Now the rest of this report is going to breakdown into case-mix information, age, payers, genders, functional capabilities, diagnoses. There is an enormous amount of information in this report. When you look at where the yellow highlights are, you're going to see that this is going to tell you how accurate this information is. You have the asterisks that are marking whether or not there is a statistically significant difference here. And you're going to be able to tell how this information could impact you. So you want to look at this when you have one printed out or right on your own screen where you can enlarge it. This is very hard to see and I know that. But these reports are incredibly detailed and so we did the best we could. But they're still quite small. And again, this is calling attention to some of the different pieces of critical information that you can see here. So that you have your agency-observed rate, you have your prior-observed rate and your national observed rate. Note that these are observed rates. This is not risk-adjusted. That doesn't apply here. But it tells you how you were in the last period, how you are now, and how that compares to the national. So you want to look at this data very carefully. There have been changes to this report with some of the OASIS changes. Many measures can not be calculated because items were removed. If you remember back we did pull a number of measures. So for example, prior conditions, patient diagnostic information and the reasons for hospitalization, those are not going to appear on here when the OASIS-D information is present on here. On the other side, there were some things that were added because of the new or the revised OASIS items. For example, the Functional Abilities are now calculated using the OASIS-D Section GG and Health Conditions and Falls will include data from OASIS-D Section J. The updates that are important to remember are that the diagnoses have been updated to match the ICD-10 coding categories. And that the integumentary section of this report was updated to include the revised pressure ulcer/injury terminology changes and the new measures for unstageable pressure ulcers and injuries. So these changes will appear when the OASIS-D data appears in here. We have to collect enough data for this to appear. And when it does, then you're going to have measure information on these new pieces. This is a Tally Report. Remember I said that you could take the agency-level information and now drill it down to the individual patients so that when you are looking at the agency-level data and something just doesn't look quite right, this gives you the ability to say, okay, let me run this at the patient level and I can now run my thumbnail down and see did I really have that many patients that were of that age group or of this age group? That many patients with these diagnoses as opposed to those? Because that's the information that you're going to use in order to do effective planning. This is highlighting the different areas so that for instance in the demographic category as I've been speaking about age, there's that column highlighted going down. And then the patients are on the far right so that you have the patients, you have every one of the different patient characteristics going across. You can select a patient and run across looking at how that was answered for each patient, or you can select a characteristic and run down to see how that was answered for all the different patients. It's a very flexible report. And it's going to give you detailed-level information. The Outcome Report, so those measures that we are looking at, what was the ultimate outcome? Here you're looking at different colored bars. And we're going to go over these. You have the outcomes listed. You have how many eligible cases there were, the statistical significance, then you're looking at each of those four color bars. Now as you look at those, there are four. The first one is the agency's observed rate. Then you have the agency's adjusted prior rate. You have their risk-adjusted now. And you have the national observed rate. So as you look at the four columns that are there, those four bars, you want to make sure that you understand what each of them is referring to so you're not missing the jackpot again. You want to be sure you're comparing apples and apples, observed to observed. That is going to make a difference in how you use this information. So what have we changed in this report going forward? We have changed the title from Risk-Adjusted Outcome Report to simply Outcome Report because not all of these outcome measures will be risk-adjusted when you see the final data. The measures on the report were reorganized into three specific groups. Risk Adjusted Status as in risk-adjusted or not, what type of a report is this? What type of a measure is it? Is it an end result outcome? Is it a utilization or resource use? And then finally, what's the source of this data? Is it OASIS-based or claims-based? Because that does make a difference. The measures that were removed are the Acute Care Hospitalization, which is an OASIS-based item, and the Emergency Department Use with Hospitalization, again, an OASIS-based item. There's a new footnote that's been added. And you really should take a look at those footnotes because they're going to help you to understand the data that you're looking at. The footnote reads "Measure results for Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened" will be frozen as of October 2019 Home Health Compare refresh and will include quality episodes ending 1/18 to December of 2018. So that that's going to affect how you look at and use this data. This is an Outcome Tally Report. Again, look at the structure. You have patients down the side. You have your SOC/ROC data. And you have going across each of the individual measures so that using the coding that we talked about before you will be able to identify how David Brown did. Did he succeed in these measures or not? Or did this measure not apply to him for some reason? So that's what you're going to be looking at. That's what the yellow is showing you, that you can actually identify in this report the agency-level data. For any measure you can now look at this patient by patient to see where you have an issue and what you need to do to correct that issue. The Potentially Avoidable Event Report at the agency level is giving you similar data with the same color bars so that you can identify how your agency has done in comparison to another. When you look at the yellow, you're going to be able to see here for instance with development of urinary tract infection, you're looking at the agency observed, the agency prior and the national observed. Bear in mind, you want to look closely at those titles. This is "observed". You want to see how many were eligible. How many patients were in this count? And then you're looking at did you improve over last year? Do you have more or less urinary tract infections that developed? Because that's going to inform how you setup your QAPI. It's going to tell you where the problems lie. We can then take that agency-level data for potentially avoidable events and we can now have a Patient Listing Report. This is such interesting information. It's one thing to know on the previous report that the color bar says that this year we had 3 times as many UTIs develop as we did last year. Hmm. Now we can take the Patient Listing Report and we'll find out who they are. And a deep dive chart audit is going to tell you a lot of things about how that might have happened. And it will help you to answer the question, was this avoidable or not? And this is showing you what a specific section looks like and gives you the information about each patient and that particular event. We can move on now to the Process Measures Report. This is going to give you similar information but this is for the process measures as opposed to the outcome measures so that you have the measures listed down the far left side of the page. And you have the color bars again that are giving you the information about the agency observed, current, prior observed and national observed rates. This is giving you the information. It's a thumbnail look for this particular measure. Am I doing better or worse than the previous period? And how does that performance compare to the national observed rate? If your performance, you have twice as many, if you're not doing well you don't have enough, then you're going to see where your areas are that you want to focus on improvement. This is the same report broken down to the patient-level now. So that, just as in the others we have a patient listing. We have the measures listed. And you're going to be able to look at the individual deeper-dive level, how every patient performed in these process measures. This is showing you how that would look so that you have here a specific measure, timely initiation of care, and you'll be able to see patient by patient, who did or did not trigger the measure. So we've talked about these reports. One of the biggest things that I hear is, well that's really great and I would love to have those, but you know what, I don't have anybody in my office that can do that anymore. We used to have Jane, and then Jane left. And you know what, she took that institutional knowledge with her. That's a problem. Obtaining the CASPER Reports is knowledge that you need to have in your agency. You are allowed to have at least two individuals who can have user IDs and passwords into the CASPER system. That's very important because if Jane left then Tom is still here and he knows how and he can teach the next second person. Institutional knowledge, it's critical that it be documented and preserved and that there is a mechanism in place so that you will always have someone who knows how to run them, how to read them and how to teach that to others in your agency. So if you're going about obtaining your CASPER Reports, this is the CMS QIES system. This is the provider website. You're going to go here so that you can now get your information but you need to log in and it's a two-level system. You're going to select what you need in the middle. You want CASPER Reporting. You're going to be able to then choose here the User's Guide if you want that, or specific tasks, what it is that you want to do. The second piece is to log into the national system. You're going to need a user ID and password. There are instructions online. If you go to the QRP website you will be able to find the instructions, the links, everything that you need if you really and truly lost that institutional knowledge, don't have anyone. Go to the website and you will get the information you need to contact the right people and go through the step-by-step process which is way too long for me to try to do at this time of the day. Checking to see if you're awake there. Okay. So you've logged in. You had a valid user ID and password, you've logged into both steps. And now you've landed. Welcome to CASPER. Okay, that's nice. You want to look carefully here. This is how you're going to obtain your reports. On the right, you have here a list of the different things that are available to you. I always wondered why they put log out at the top. But you have your folders so that you can view the different reports. Documents will be in there, you have lists of the reports that you can select. You pick the different categories and the specific report that you want. In the cue means that you've selected reports, requested them and they are pending while the data is being gathered and put together. And then when it's all done it will appear in your folder so that you can then open it up and look at it. Those are the pieces you will use the most so that you would then select Reports so that you can now identify here what it is that you would like to run. You have in the listing on the right Quality Improvement Reports, Patient-Related Characteristics at the agency level, you have Agency Patient Characteristics Case Mix Tally Report, Review and Correct, Trend Analysis. This is a wonderful report. We just didn't have time to put them all up there so that I could really dive right into them. Years and years ago somewhere there is someone who was my quality manager when I was an administer and this woman is falling off her chair laughing hysterically because now I understand these reports. I know how to use them and I get all excited about data. But a few years back, more than I care to admit, Patty would come in and go, oh, you know, Kathy you need to look at this because this is our quarterly reports. And I would go, please. I don't do numbers. Just tell me what we need to do and then go do it. And that's not how I should have been doing this. But I didn't understand the reports. And I didn't know what they could do for us. And that was really bad. And I know that you really do want to understand these. So when you get back home, brush off your user ID and password, shut the door, turn off the phone and give yourself at least an hour to just waltz around, look at different things, run them, see what they look like. Just do that on a regular basis for awhile. You'll get comfortable. And after a while they'll really start to make sense and they'll matter, because they do. So those are the ones you will see there. And you can select what you want. You fill in what time periods you want. And then you'll run the report and it will appear in the cue as pending. Then it moves to your folder. Go back in and click on the folder and you'll see the report. And you can download them so that you'll be able to have them to really study as you go along. There are some other additional very helpful reports that we're going to look at before we go into our case study. The OASIS Error Detail by Agency, this is located in the Provider Report category. You request this by date range. Is anybody running this? Please, I hope. Oh well, we've got a couple. You are going to look at this -- you want to look at this on a regular basis. This gives you a list of all the errors encountered in the assessments that were submitted during the date range you selected so that next week on the 15th if you were to go in and run this report for all the OASIS that you submitted from 2-1 to 2-28 of 2019, you would now know what OASIS you submitted had errors in them. And you would know what your percentage of error was and you would know if you had an issue with a particular error showing up on a regular basis. It tells you by the assessment ID whether the error is a warning or a FATAL error. An assessment with a FATAL error is not accepted into the database. And it's not going to be included in your quality calculations. So that's why you really need to be running this on a regular basis so that you will know what it's telling you and you can make the corrections as you need to. This is what the report looks like when you run it. It does look very daunting, I will admit. Take your time, look at it carefully. Sit with the person who routinely runs and submits the OASIS data. The two of you together want to be looking at this to see where the errors lie, what kind they are, whether they're persistent trends, and what you need to do to correct the issues both at the patient level and the agency level. The OASIS Assessment Print Report is in the CASPER Agency Provider Report category. You're going to request this by the assessment ID, and that you would get from the Final Validation Report. This is going to show you all the values that were submitted for that assessment so that now you can easily identify what values submitted for OASIS items were actually included in the quality measure calculation. This is what it looks like. So here you have this Section 2 comes from the Patient Tracking Sheet. You have the items listed. You have the certification number and you just go right on down through patient by patient. Then you have Provider Preview Reports. These are automatically generated and saved in your provider's shared folder in CASPER. This gives you agency-level results that will be posted on the Compare websites. Two of these you want to pay close attention to, your Home Health Compare Provider Preview Report and your Quality of Patient Care Star Ratings Provider Preview Report. These are available in that shared folder three months in advance of the next Home Health Compare refresh. So you really do want to take a look at this. You need to know what's there, what data is going to appear and what it means. It's important that you review your data. You can email this web link on your slide if you have questions about these reports. The order of the measures on the report that you're looking at may not be the same when it appears on Home Health Compare. Remember that the information that is actually on the screen in Home Health Compare is intended for the layperson. And so, especially the titles of the measure are not the consumer language that will appear on the Home Health Compare website because we need to use language that the layperson is going to understand. There is a crosswalk between the titles the layperson would understand and see on the Home Health Compare website and the measure titles that we are accustomed to seeing. And you can find that on the Home Health Compare website. In Provider Preview Reports, if you find that you believe there are corrections that need to be made, they need to be made prior to the applicable quarterly data submission deadline, that quarterly freeze date. This is approximately 135 days after the end of each calendar year quarter as is noted on the provider Review and Correct Reports. There is a 30-day preview period prior to the public reporting being released which begins the day reports are issued to the providers in your CASPER system folders. You will not have the ability to request correction of underlying publicly reported data if the data correction deadline has passed. So we can't help you if the deadline went, this is yet another reason why going into the system on a regular basis, running these reports, studying them carefully, giving yourself the time and the ability to actually make the changes if changes need to be made, this is what it looks like. And again, as with many of the other reports, the print is very small. Putting it up here on the slide we wanted you to be able to see it, but it's very small print. You really actually need to have this printed out and in your hands in order for it to be truly helpful to you. But it will give you the information that we've discussed and listed out and it will make it possible for you to identify anything that you feel needs to be reviewed and possibly corrected. Let's take a moment and look at Home Health Compare. I remember I was still running an agency when this first came out. I'm from Connecticut. And the Hartford Courant and I think the Bridgeport papers and the New London Day all put all 110 Connecticut agencies and their Home Health Compare ranking and their information was plastered on the front page of the newspaper. And every agency was in a total panic because how could they give this information to the public who won't understand what they're reading? People are much more facile these days. They do understand what they're reading. So you need to be ready to understand what's in these reports and understand how your viewing public may be responding. So the Home Health Compare website provides access to quality measure results tailored for the public consumption, the ability to search for home care agency by geographical location, city, state and ZIP code. The new quality measures were added to Home Health Compare on January 1, 2019. Assessment-based measures that appear where the Percentage of Residents or Patients with Pressure Ulcers That Are New or Worsened, Short Stay, the Drug Regimen Review Conducted with Follow-Up for Identified Issues, that's tomorrow's discussion, and the claims-based measures of Medicare Spending Per Beneficiary Post-Acute Care Home Health, Discharge to Community for Post-Acute Care Home Health QRP. So these are the pieces that have been added on 1/1/19. You can look at these different resources for additional information that you may need in order to understand the reports that you've been given to run that you have sitting on your desk looking at you. You want to look at each of these links so that you get the guide, you get the information, they will help you to understand. And it's all going to make so much more sense when it's here in front of you instead of in miniature print up here. You'll be able to identify where the things are that you need to work on. So you have the Reporting User's Guide. You have a link here to obtain it. You have a Reference and Manuals page on the QTSO website. And you have all of your education coordinators. There is an OASIS Education Coordinator for every state. So you do have one and it would be very helpful to you to go here, find out who that person is. And if you feel that you need education or training, reach out to them. Quality Measures and OASIS Data Collection Guidance is at this link. The Medicare Prospective Payment System Policy Mailbox is listed at this one. And the QTSO Help Desk is on this slide. You have an email, and a website and a phone number. I will tell you, I have found them extremely helpful. They're very easy to deal with. They're very patient. And they will work with you to get your user ID and password updated. They'll work with you to do whatever you need to do and to understand what you're working with. So now we're going to do something a little different. In your packets on the table the packets that you were given, you have some sample reports. We're going to do a little activity today. We're going to work with this scenario. You are the Quality Manager at Happy Harbor Home Care. It's in Baltimore, Maryland. It's right out there on the Inner Harbor. On a regular basis you have been accessing, analyzing and using CASPER Reports to support your agency's quality program. When you reviewed your Process Measure Report for Quarter 3, 2018 you have identified an opportunity for improvement. At your table, work as a group and review the sample reports that we have provided you. You have a Reports Activity Worksheet to guide your review and analysis. We're going to come back together in roughly 20 minutes. If you are finished sooner, I'm going to ask for a show of hands in 15 minutes to let us know how you're progressing. If you are done earlier then we will come back together and debrief on these activities. I'm going to leave this slide up. This is what you're going to be working on. Review the Process Measures Report to identify which measure your agency should target for improvement and how does the data support that conclusion. Use the Process Tally Report, identify the patients who did not achieve the numerator for the quality measure identified for improvement. Use your OASIS Assessment Print Report to summarize the findings for the patients who did not achieve the numerator. And think about how you will use this to inform your Performance Improvement Plan. We'll get back together in 15 minutes at exactly a quarter until. Okay let me see a show of hands. Which tables are all done? (Counting) Okay, how many are three quarters done? Almost there? No? How many have got lots of work to do? It's a quarter of. What I would like to do is to try to go through these reports. And it's a quarter of. I would like to go through these reports get some feedback from you on how you answered these questions and then we'll talk about activity plans and what you think you might do to address what you identified. Okay, let's remember the questions that we were asked to answer. Using the Process Measures Report, identify which measures should be targeted for improvement. Then using the Process Tally Report, identify the patients that did not achieve the numerator for the measure that you selected for improvement. Using the OASIS Print Report, summarize the findings for each patient who did not achieve the numerator. And what conclusions can you draw from this? And then lastly, how will the information you've collected inform your next steps in developing a Performance Improvement Plan? So you have in your packet the Process Measures Report. We have highlighted on here the Drug Regimen Review Conducted with Follow-Up for Identified Issues. There were five patients who did not achieve the Drug Regimen Review Conducted with Follow-Up Quality Measure. Timothy Collins in each episode did not achieve that measure, Nancy Edwards and Linda Green. How many at your table selected this as your measure to improve? Excellent. You guys are doing great for the end of the day. You've got more stamina than I do. Okay. So in the Process Tally Report here we are able to see the patient, the episodes I referenced. We have poor Mr. Collins in three episodes. Nancy Edwards and the last one there. So we know now what happened at the patient level. So let's take a look at the OASIS Assessment Print Report for Mr. Collins. Does anybody want to take a stab at telling me what it says, what you learned from it? Oh, come on. Somebody must be brave. Oh, good. Come on up. Here comes the microphone. And remember, this is a safe place. Nobody gets to giggle because I will come beat them with my stick. (Laughter) So what did you learn from the OASIS Assessment Print Reports for poor Mr. Collins? »» Can you check that, the volume wasn't up there. Okay. So he did not have follow-up. This is clearly an issue because the follow-up must be done and the follow-up with the physician is always a two-way street. It's not enough for us to leave the message. We need to have a two-way communication. So what does the OASIS Assessment Print Report tell us about Nancy Edwards? Who wants to tell me what that one showed? There must be somebody, come on now. You go, Charlotte. (Laughter) Charlotte's going to find a victim if nobody volunteers. »» There was an issue with Nancy Edwards medication review. And there wasn't follow-up with a physician. »» Very good. So there was again no follow-up with the physician. What about Linda Green? What was the issue with her? Was it the same? No, ah-ha. So if it was not the same, what was the issue? They didn't even assess it, oh my. »» I can't find the page but she was not assessed and there's no information. »» Well that certainly is a deficiency isn't it? »» That is definitely a deficiency. »» Okay. So now the question is, how will the information that you've collected from these CASPER Reports inform your next steps to develop a Performance Improvement Plan? We need to -- we've learned something with Mr. Collins three times. There was no two-way communication follow-up with the physician. With the second patient, the same was the problem. With the third one, we apparently didn't even assess it at all. So what does this tell us? What would you think that you would need to do in order to address this problem? I'm hearing a lot of education. So you want to think about when you do staff education it's important that when you make the Activity Plan for this Performance Improvement Plan that you are looking at, okay here's the data I found. I ran these reports, I analyzed it at the patient level. I identified the measure. I identified the who and the how and the why. Having done that, now what am I going to do with it? Staff education in and of itself is a laudable endeavor. But if you don't follow-up, if you don't continue to audit, run these reports and look to see if you have achieved a sustainable improvement that the measure is being assessed and that anytime it is not met, you are looking to see what happen? Why did it happen? What can we do to change that so that it doesn't happen again? So the take away from this activity today is that these reports do not exist in some kind of esoteric quality vacuum. They are usable information at a nitty-gritty daily clinical practice level. So as I'm sure you know, Charlotte and I, and most of the speakers, we get a lot of questions from agencies, we get requests for okay, so you've taught this class and I went to that class, so what am I supposed to do with this? And when am I supposed to run these reports? And what should I be doing with them? I would encourage you when you go back to your agency to sit down and think about agency policy and practice. Think about your Quality Assurance Performance Improvement Plan. Think about how these reports could help you. And then you want to think about policy and practice in terms of how often would I run these reports? Which ones would I run monthly? Which ones would I run quarterly? Which ones do I only need yearly? If I ran my Agency Patient Characteristics on a quarterly basis would I see enough difference in, or a ranking in the diagnoses? Would it tell me, do I need a telehealth program? Do I need a diabetic educator? What does it tell me? You won't know if you don't run it, that Potentially Avoidable Events Report. If you run the patient listing on a monthly basis you'll know when a new person pops up and what measure they popped up under, and you'd be able to do the chart audits that will help you to make a plan that will help you to improve the patient care that you're providing. Those OASIS reports, the Error Report, the Submission Data, these are things you need to know about monthly. Making sure that your OASIS assessments are timely filed, that the information is accurate 100%, and that it goes through smoothly and easily and gets accepted. Those are very important things that you need to know on a very regular timely basis. So I'm going to end here. And we will take questions for a couple of minutes. And then Brigitte's going to close out our day for today. So does anybody have any questions? Oh my goodness, Charlotte. That hand went up really fast. And I'm assuming of course that I'm going to be awake enough to answer you. I think I'll have some coffee so I can answer you properly. »» Thank you. Can you tell me how to access these reports again? How do I obtain the user name? »» Okay. Let's start at the beginning. You need a user ID and password at two different levels. So the first thing you're going to do is go to the QTSO website. Go to the Home Health Quality Reporting webpage. You're going to find the links and all the information there for how to get a new user ID and password if you have lost the institutional knowledge. There are also manuals and instruction there on how to proceed step by step. So that's your first step. Go back to the Home Health Quality Reporting Program page. Start there. You'll have information on how to go to QTSO and get what you need. In addition, run the report to find out who the OASIS educator is for your state. Contact that person and have them help you with the process. Because teaching you is what they're there to do to help you. And that will get you started. And then you'll be able to work your way through and hang on to the slide deck because the slides are going to show you the different screens and the process for running the reports once you have your new user IDs and passwords. Okay. »» Thank you very much. »» You're welcome. I'm very practical. I think that it's very helpful to get step-by-step instructions. Somebody always needed to take me by the hand and say okay, do it this way. And then I would write it down and I would do it that way. Anyone else? No? Well I congratulate all of you. You made it through the day! Yay! Give yourselves a round of applause. You made it. I hope that this was helpful. We've talked about doing this particular activity for quite some time and I'm really glad we did. I think that everybody benefited and I think we all learned a lot from each other. Brigitte do you have