Home Health Value-Based Purchasing – A Marathon, Not a Sprint
PUBLISHED: December 7, 2021
In the CY 2022 Home Health Final Rule, CMS officially ruled that Home Health Value-Based Purchasing is expanding to all 50 states effective January 1, 2023. However, pre-implementation will begin January 1, 2022. This pre-implementation year will give agencies a head-start to get processes in place for the first performance year (2023).
While 2023 will be the first performance year, 2025 will be the first payment year. Rate adjustments for the first payment year will be capped at 5%.
CMS launched the Home Health Value-Based Purchasing (VBP) as a part of a nine-state demonstration in 2016 to financially incentivize quality care and patient outcomes.
“This model is designed to support greater quality and efficiency of care among Medicare-certified Home Health Agencies (HHA) across the nation. The HHVBP Model supports the Department of Health and Human Services’ efforts to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people and communities.” – Centers for Medicare and Medicaid Services (CMS)
Imagine running a marathon without training for the race or when you only run once per quarter. Good intentions alone are not enough to help you reach your end goal. If your organization is only prioritizing reviewing the impact of your quality measures when the quality reports are released, you will be behind the crowd. VBP is the next marathon in home health. With 2022 set as a pre-implementation year – training starts now – here are three steps that agencies can begin with to properly prepare for HHVBP.
Perform a data analysis to identify areas of strength and weakness with OASIS items is an ideal starting point. When doing so, be sure to consider the impact of stabilization on your outcomes and remember, OASIS items different from core functional items are used for risk adjustment when calculating HHVBP scores.
Assess how your agency scores compare to the state/national averages and find your weak points and compare your agency to your 2019 performance. This assessment can also be done by thoroughly reviewing your satisfaction surveys.
Provide targeted staff education on areas that are likely to have the most impact on your agency’s HHVBP scores.
Key Considerations with Home Health Value-Based Purchasing
One of the key differences between the demonstration and the final rule is the change from state cohorts to nationwide cohorts based on all HHAs. This allows for benchmarking and competition for payment against other HHAs of similar size and is based on the same set of measures.
The larger-volume cohort (7,084 agencies) will be aligned with the group of competing HHAs that administers the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey, in accordance with the HH QRP regulations concerning the HHCAHPS survey in § 484.245(b)
The smaller-volume cohort (485 agencies) will be aligned with the group of HHAs that are exempt from submitting the HHCAHPS survey under HH QRP under § 484.245(b)(1)(iii)(A)
In addition, take into consideration the impacts of COVID and the Public Health Emergency (PHE), the baseline year is CY2019 (January 1, 2019 through December 31, 2019). The data from this baseline year lays the foundation from which each respective HHA’s performance is measured for purposes of calculating achievement and improvement points under the expanded model.
Quality Measures that Impact the Calculation of the VBP Total Performance Scores
Improvement in Dyspnea (M1400)
Discharged to Community (M2420)
Improvement in Management of Oral Medications (M2020)
Total Normalized Composite (TNC) change in Mobility:
Toilet Transferring (M1840), Bed Transferring (M1850), Ambulation/Locomotion (M1860)
Total Normalized Composite (TNC) change in self-care:
Grooming (M1800), Upper Body Dressing (M1810), Lower Body Dressing (M1820), Bathing (M183 0), Toilet Hygiene (M1845), Eating M1870
Acute Care Hospitalization
(ACH) during the first 60 days of home health
Emergency Department use without hospitalization during the first 60 days of home health (ED use)
HHCAHPS Survey Measures:
Care of patients/professional care
Communication between providers and patients
Specific care issues
Overall rating of home health care
Willingness to recommend the agency
Check out the top FAQs for VBP asked by top home health organizations nationwide
What scores will be reported publicly for VBP? Percentages?
There will be annual public reporting of quality performance data to include national benchmarks and achievement thresholds, HHA-level performance results for HHAs that qualify for an annual payment adjustment that includes applicable quality measure scores, Total Performance Scores (TPS) and percentile rankings, improvement thresholds, and payment adjustment percentages. Each agency’s TPS score and corresponding performance years percentile will be reported for the purposes of VBP.
Do agencies with a lower baseline score in baseline year 2019 have a better opportunity to show improvement?
The formula for calculation of improvement is the HHA performance score. The HHA improvement threshold is divided by the benchmark minus their improvement threshold and then multiplied by 9. However, the calculation for achievement is multiplied by 10 so agencies with achievement will come out with higher scores generally speaking. So, each agency will get an achievement score and an improvement score. The highest of the two scores will be used. Improvement is against self and how much the agency improves. Achievement is how the agency did against other agencies in the cohort. If agencies are thinking about not scoring well on OASIS now, so they have further improvement later, remember the baseline year (2019) is already established. Agencies need to work on OASIS proficiency, best practices, and HHCAHPS now.