The Impact of Home Health Value-Based Purchasing

On November 5, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final rule for the Home Health Value-Based Purchasing (HHVBP) Model.  The goal of this model is to ensure more efficient and higher quality care to Medicare patients.  It has been designed to leverage the successes and lessons learned from other value-based purchasing programs such as the Hospital Value-Based Purchasing Program.

Model Details
The HHVBP Model was authorized under the Affordable Care Act (ACA) as a mechanism to support the Department of Health and Human Services’ efforts to develop a health care system that delivers improved care, spends dollars more wisely, and results in healthier people and communities overall.  CMS began implementing the HHVBP Model on January 1, 2016, and it will run through the end of calendar year 2022.  It is estimated that the HHVBP model will provide improvements in the home health industry, which will result in $380 million in savings due to the reduction in unnecessary hospitalizations and SNF (skilled nursing facility) usage.  However, the HHVBP Model currently affects Medicare-certified HHAs (home health agencies) in only the following nine states:

  • Arizona
  • Florida
  • Iowa
  • Maryland
  • Massachusetts
  • Nebraska
  • North Carolina
  • Tennessee
  • Washington

These states were selected in order to represent each geographic region in the country.
The model not only tests new quality measures for home health agencies, but enhances the public reporting process as well.  The model helps determine whether a payment incentive per the increasing scale of annual adjustments listed below will improve provider performance significantly:

  • A maximum payment adjustment of three percent (upward or downward) in 2018,
  • A maximum payment adjustment of five percent (upward or downward) in 2019,
  • A maximum payment adjustment of six percent (upward or downward) in 2020,
  • A maximum payment adjustment of seven percent (upward or downward) in 2021, and
  • A maximum payment adjustment of eight percent (upward or downward) in 2022.

As you can see the HHVBP Model not only offers greater potential rewards for high performing HHAs, but low performing HHAs will experience increased downside potential.

The HHAs’ scores are based on the quality of care delivered to all patients as compared to the performance of similar agencies in the same state, and their past performance regarding these identical measures.  With this model, any selection bias is eliminated, participants are representative of home health agencies across the nation, and meaningful results are generated for all Medicare-certified HHAs countrywide.

Quality Measurements
A set of measures from the Outcome Assessment Information Set (OASIS) and Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) documents are used to determine a HHA’s total performance score.  However, there is another way to produce this score.  It can be based on claims data plus three new measures where points are earned just for reporting the data in the HHVBP portal.  Below are further details on the exact number and types of measures used to calculate the total performance score:

  • Six (6) process measures from existing OASIS data collection.
  • Eight (8) outcome measures from existing OASIS data collection and two (2) outcome measures from claims data.
  • Five (5) HHCAHPS consumer satisfaction measures.
  • Three (3) new measures  – points are achieved for merely reporting data.

In Conclusion
This new model brings with it many questions.  If your HHA is located in one of the nine states impacted by the HHVBP Model, and you need assistance navigating these new waters, please feel free to contact one of our experts.  The 5 Star team is always current on happenings in the home health and hospice markets.  We look forward to hearing from you!

Source: Centers for Medicare and Medicaid Services Website

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