Navigating the Future: Leveraging HHVBP Insights for Optimal Payment Adjustments

As home health agencies face ongoing regulatory changes, particularly with the Home Health Value-Based Purchasing (HHVBP) model, the stakes are higher than ever. With the 2024 HHVBP reports available and the first set of annual reports coming in 2025, agencies need to understand how these data points will shape their future payment adjustments. In a recent McBee webinar, we shared key insights on navigating these reports. 

Overview of the Current HHVBP Model

The HHVBP model incentivizes home health agencies to improve the quality of care by tying performance metrics to payment adjustments. The scoring is based on a set of performance indicators, including OASIS-based measures (self-care, mobility and medication management), HHCAHPS (patient satisfaction surveys) and claims-based measures (such as acute care hospitalization and emergency department use). 

The Total Normalized Composite (TNC) score is a critical component, breaking down into self-care and mobility scores at 8.75% each, along with oral meds, dyspnea and discharge to community metrics, each counting for 5.83% towards the Total Performance Score (TPS). Patient satisfaction (HHCAHPS) makes up 30% of the total score while claims-based measures account for the remaining 35%, split between acute care hospitalization (26.25%) and emergency department use (8.75%). 

Big Changes for 2025 

The most significant shift in the HHVBP model is set for 2025. Instead of separate TNC scores for self-care and mobility, the two will be combined and their weighting will increase to 20% of the total performance score. This change highlights the need for agencies to focus on GG item accuracy—measures that assess functional mobility and self-care abilities—as they will carry more weight in the coming years. 

The oral meds measure’s contribution to the total score will increase from 5.83% to 9%. This emphasizes the understanding that managing medications is key to improving patient outcomes and cutting down on rehospitalizations—a challenge many agencies face. 

Claims-based measures will also see a revision with the Potentially Preventable Hospitalization (PPH) measure. It replaces acute care hospitalization in the star ratings. This new measure, weighted at 26%, looks at how many patients are hospitalized within their stay or within one day after discharge. Discharge to community (DTC) will look at whether patients avoid hospitalization or death within 31 days post-discharge, accounting for 9% of the total score. 

Understanding and Interpreting the Reports 

During the webinar, we discussed a step-by-step breakdown of how to interpret the HHVBP reports, especially when navigating the iQIES and Care Compare platforms. The reports provide agencies with a wealth of data, but knowing how to interpret it effectively is key to making strategic improvements. 

Each agency is scored based on achievement and improvement points. Achievement points compare the agency’s performance to the median of their peers (the 2022 baseline year), while improvement points compare the agency’s performance to its own prior results. The good news is that agencies are awarded whichever score is higher, allowing for a second chance if they can show meaningful improvements, even if they don’t outperform their peers. 

For example, an agency may not outperform its peers in preventing emergency department use, but if it has improved since 2022, it can still earn improvement points.  

It’s important to note that data from 2023 will be the new baseline year in 2025. 

Best Practices for Addressing Weaknesses 

Understanding weaknesses is critical to long-term success. Agencies must identify the specific areas where they are underperforming, whether in claims-based measures, OASIS accuracy, or HHCAHPS survey responses. Common pitfalls include failing to accurately score functional measures on the OASIS assessments, particularly for GG items, and underperforming on patient satisfaction surveys. 

Here are some best practices you may consider to address these issues: 

GG Item Accuracy: The combined self-care and mobility score for 2025 means agencies must train staff to accurately assess and document these areas. Incorrect scoring can negatively impact both payment adjustments and overall care quality. 

Oral Medication Management: With the weighting of oral meds increasing in 2025, agencies need to focus on improving their processes for medication management. This might include better staff education or enhanced communication with patients about medication adherence. 

PPH and Discharge Planning: To reduce potentially preventable hospitalizations, agencies must be proactive in discharge planning. Make sure patients have the necessary support systems in place, including transportation, follow-up care and access to medications. 

Preparing for 2027 Payment Adjustments 

The payment adjustments home health agencies receive are always based on a two-year delay. The work agencies are doing in 2024 will influence their payments in 2026, while the changes they implement in 2025 will affect their payments in 2027. 

The delay gives agencies some time to prepare for upcoming changes, but it also means they must act now. The 2025 performance year will feature all the new measures, and those scores will directly impact payments in 2027. Agencies that are proactive about adapting to the new GG items, PPH and oral medication measures will be in a better spot to secure favorable adjustments down the line. 

The Path Forward: Education and Strategic Adjustments 

Ongoing education and strategic planning are important factors for home health agencies to consider. McBee offers staff education, particularly around OASIS accuracy and claims-based measures. Also, outsourcing OASIS reviews or conducting audits may help agencies identify problem areas and make sure they are accurately capturing patient data. 

By leveraging the insights from the HHVBP reports and staying ahead of regulatory changes, home health agencies can improve patient outcomes, reduce hospitalizations and secure favorable payment adjustments. 

Home health agencies will want to approach the HHVBP model with a proactive mindset. With significant changes ahead for 2025, agencies need to focus on improving GG item accuracy, medication management and discharge planning. By interpreting their HHVBP reports correctly and strategically addressing weaknesses, agencies can set themselves up for success in the years to come. 

Click here to listen to our recent webinar focusing on the CY 2025 Home Health Final Rule

About the Author

Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, VP of Education and Quality

Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, is the VP of Education & Quality at McBee, bringing over 35 years of expertise in home health and hospice. As a registered nurse and home care attorney, she specializes in regulatory compliance. Lisa has held various roles, from field nurse to executive, managing accreditation surveys, acquisitions, and regulatory crises. In 2004, she founded Selman-Holman & Associates, offering consulting, coding and OASIS review services. Lisa is a renowned educator, known for turning challenges into achievements. Joining McBee in 2021, she leads education initiatives at the Post-Acute Academy, providing courses for home health and hospice staff and executives, including clinical, regulatory and onboarding requirements.

About the Author

Michelle Horner, Manager of Clinical Consulting and Education

Michelle Horner, BSN, RN, HCS-O, HCS-D, HCS-H, COS-S is the Clinical Consulting and Education Manager for McBee. She has more than 30 years of experience in healthcare with an extensive background in critical care and home care. Michelle has been instrumental in the content creation for the McBee Post-Acute Academy. She currently specializes in Quality, Clinical, and Regulatory Consulting and Education. Michelle develops and provides custom on-site client education programs. She speaks regularly for various home care associations. Her expertise regularly appears in the Decision Health Diagnosis Coding Pro and she is a subject matter expert contributor for several Decision Health publications. Michelle currently serves on the AHCC’s Board of Medical Specialty Coding and Compliance Certification HCS-D and HCS-O Committees.