As the 2022 calendar year comes to an end, there is one common question on the minds of many home health agency (HHA) leaders: how can we deliver a consistent higher level of quality care? With less than three months to go before the first Home Health Value-Based Purchasing (HHVBP) performance year kicks into effect, it’s time to get your act in gear.

The Center for Medicare and Medicaid Innovation (CMMI) initially implemented the HHVBP Model on January 1, 2016. At the time it was only in effect in nine states, however it has since resulted in an average 4.6% improvement in HHA’s total performance scores and an average annual savings of $141 million to Medicare¹. This success has catapulted further expansion of the Model to all 50 states, with 2022 serving as the pre-implementation year and 2023 the first full performance year, impacting payments beginning in 2025.

The new payment system will award Medicare-certified HHAs with higher quality care ratings, and penalize those who fall short of their geographically-located peers. Payment adjustments can fluctuate from an increase of 5% to a decrease of 5%, depending on the HHA’s total performance scores (TPS).

While the Centers for Medicare & Medicaid Services (CMS) have released various resources and training to help HHAs for what is to come, many are still vastly underprepared. Those who are tempted to maintain their status quo may have a harsh wakeup call when the 2025 payments begin rolling in – and by then it may be too late. Agency leadership can avoid this unnecessary financial risk by creating a quality care plan for their organization now.

Breaking Down the Data

Before HHAs can take action to advance their performance scores, they must first understand the calculations behind it. The TPS score is a result of data collected from three possible sources:

1. Outcome and Assessment Information Set (OASIS)
2. Medicare claims
3. Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey

The data collected from each of these sources are based on specific measures focused on improving quality of care and cost efficiency. These include the following categories:

OASIS-Based 

• Improvement in dyspnea/dyspnea
• Discharged to community
• Improvement in management of oral medications/oral medications
• Total normalized composite change in self-care/TNC self-careTotal normalized composite change in mobility/TNC mobility

Claims-Based

•  Acute care hospitalization during the first 60 days of home health use/ACH
  
• Emergency department use without hospitalization during the first 60 days of home health/ED use

HHCAHPS Survey-Based

• Care of patients/professional care
• Communications between providers and patients/communication
• Specific care issues/team discussion
• Overall rating of home health care/overall rating
• Willingness to recommend the agency/willing to recommend²

Establish Your Own Benchmark

Knowing the factors your agency will be “graded” on, it is important to find your baseline before you can really hone in on any area in need of attention. Keep in mind that payment calculations will be based on the actual performance year, performance in your baseline (2019) year, as well as performance compared to your cohort/peers. When you have a good grasp on where each of these figures stand, you will be in a better position to identify and prioritize areas of improvement while there is still time to correct them.

Set Clear Expectations

In the five years the HHVBP Model has been in play, it has reported to fulfill each of its goals, resulting in fewer unplanned acute care hospitalizations, less use of skilled nursing facilities, decreased Medicare spending, and improved patient care overall. It is very unlikely it will be going away anytime soon, and there may very well be other CMS quality initiatives that follow. The sooner your agency gets on board with the industry’s new expectations, the more it will benefit in the long run.

Take the time now to develop quality improvements plans, by examining your internal processes, identifying trends, and looking at the root cause of any issues you uncover. Set firm expectations for your performance goals, and communicate progress along the way to those vested in the process.

Enhance Outcomes with Richter

As the industry’s leading LTPAC performance advisors, we listen, analyze, strategize and implement customized solutions to Enhance Outcomes in every facet of your organization. To learn more about our solutions, contact us here or call us at 866.806.0799.

¹ https://innovation.cms.gov/innovation-models/expanded-home-health-value-based-purchasing-model 

² https://innovation.cms.gov/innovation-models/expanded-home-health-value-based-purchasing-model