Home Health VBP pilot is promoting quality care

Scrubs with Stethoscope on Hanger Horizontal

Be it ever so humble, there’s no place like the nine-state pilot of CMS’s Home Health Value-Based Purchasing (VBP) Model for supporting greater quality and efficiency of care among Medicare-certified Home Health Agencies (HHAs) across America.

The model was introduced January 1 of this year by the Innovation Center of the Centers for Medicare & Medicaid Services (CMS). Why? To support efforts by the Department of Health and Human Services to build a better, more cost-effective healthcare system that improves the quality of care and results in healthier people and communities.

What does the Home Health VBP Model do?

Best practices are best practices for a reason: they deliver quantifiable results in the real world. And that’s the idea behind the Home Health VBP Model. Experts at the CMS Innovation Center believe that HHAs can apply the best practices and lessons learned from other value-based purchasing programs to accelerate and intensify the shift from volume-based Medicare payments to a more efficient home health model that’s smart about how it spends healthcare dollars and is focused on the delivery of a higher quality of care. In effect, the CMS Innovation Center is betting on — and promoting — outcomes rather than activities to improve the quality and delivery of home healthcare services to Medicare beneficiaries.

To create a total performance score, the Home Health VBP Model evaluates Outcomes (which include the HHCAHPS composites), Clinical Process, and New Measures. This is similar to the way in which the Hospital VBP factors in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), plus Safety, Clinical Care, and Efficiency for inpatient hospitals.

How will the Home Health VBP Model make this happen?

Specifically, the Home Health VBP Model is:

  1. Offering incentives for providing higher levels of quality care more efficiently;
  2. Studying and evaluating new ways to develop and implement measures to improve quality and efficiency in the home health setting; and
  3. Strengthening current public reporting processes.

Home Health Agencies in nine states — Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington — representing every geographic region of the country are piloting the model now. Each of these states will be held to its own set of Achievement Thresholds and Benchmarks. Keeping in mind the two-year difference between the calendar year and the federal government’s fiscal year, 3% of the reimbursement that the HHAs in these states are eligible to receive from CMS is at stake in FFY 2018 (performance in calendar year 2016), with the payment adjustment (upward or downward) increasing to 5% in FFY 2019, 6% in FFY 2020, 7% in 2021, and 8% in FFY 2022. The baseline used for all five pilot years was January through December of calendar year 2015.

Designed with no selection bias, the Home Health VBP Model pilot is representative of home health agencies nationally and includes enough participants to generate meaningful data reflecting the performance of Medicare-certified HHAs as a whole.

The 2017 Home Health Prospective Payment System Proposed Rule issued July 5, 2016, did not change any of the administrative requirements for Home Health CAHPS. Home Health Agencies with fewer than 60 HHCAHPS-eligible patients from April 2014 through March 2015 are exempt from these requirements.

PRC will continue to collect HHCAHPS data throughout the pilot period and beyond: nothing is changing. If your organization is interested in learning more about the pilot or about the Home Health Consumer Assessment of Healthcare Providers and Services (CAHPS), just contact us.

Choose excellence. Choose PRC.