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Driving success under Home Health Value-Based Purchasing (HHVBP)

Feb 02, 2022

The Home Health Value-Based Purchasing (HHVBP) model is an incentive system. It’s designed to give Medicare-certified home health agencies (HHA) incentives to provide higher quality and more efficient care.

HHVBP has the capacity to impact every agency’s Medicare reimbursement by up to 5%, positively or negatively, beginning in 2025. (For an agency with $5 million in Medicare reimbursement, earning or losing that incentive pay could represent a $500,000 revenue swing.)

Calendar year 2022 is a pre-implementation year, meaning now is the time to define your baseline, understand performance measures and make plans to earn your full reimbursement. Beginning in 2023, your performance data will be used to set baseline numbers that will impact future payments.

What’s behind HHVBP?

In January 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the HHVBP model in all Medicare-certified HHAs in nine states: Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington.

According to CMS, the model resulted in an average 4.6% improvement in HHA quality scores as well as average annual savings of $141 million to Medicare, due to reductions in hospital and skilled nursing facility stays. Based on that success, CMS is instituting a national rollout.

It’s worth noting that the HHVBP pilot program showed no impact on the use of home health services. Analysis suggests no effects on agency entries or closures or on access to home health care.

Overall, agencies in the HHVBP pilot reported an overall favorable outlook on the program. Generally, HHVBP can be seen as a win for the industry, with the understanding that the better quality of service you provide the greater your reward for those services.

How does HHVBP work?

Quality performance data from 2023 will be used to calculate payment adjustments in 2025 — up to 5% positive or negative on all Medicare payments

Home health agencies will compete for incentive payments based on identified improvement and achievement metrics derived from claims data, OASIS items and Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey responses. An analysis system will assign points based on the national percentile or on the individual agency’s improvement — whichever is better.

Data will be risk adjusted, similar to the current OASIS risk adjustments. CMS understands that home health agencies are different across the nation. They all serve different demographics and different kinds of patients, and CMS has adjusted the value-based purchasing model accordingly.

However, be aware that you will be competing on a national level. Unlike Home Health Compare Quality and Survey star ratings, which are compared on both a state and national level, with HHVBP your agency is going to compete with everyone across the nation in order to get an incentive payment (or penalty).

Five-star rating does not equal HHVBP success

Home health star ratings will play a part in HHVBP measurements. However, you can be a five-star agency and still not be eligible for the 5% payment bump. That’s because, for the first time, agencies are experiencing the impact of how much they improve the patient as opposed to showing any improvement.

For example, let’s say you’ve improved a patient from a 2 to a 1 in a particular measurement. That’s a positive to your star rating. But if you have a patient who has improved from a 4 to a 1, then you’ve improved that patient three steps. When you’re able to move a patient more steps, that’s going to have a bigger impact on your valued-based payment placement.

That means it’s going to be very important to start looking at a patient’s potential for improvement upon referral, rather than just, “I can improve this patient.” If you wait until the admission process starts, the first visit, you are locking yourself in to a situation where the potential improvement of a patient is limited, resulting in a lower VBP standing.

How can you prepare for HHVBP?

HHVBP is coming. How agencies react and operate now will drive success for their future. Use this preparation year to get ready. By following these five steps, you’ll be on your way to maximizing your Medicare reimbursement:

1. Know your baseline

Chances are, you have an electronic medical records (EMR) system already housing your agency’s OASIS data. You should be able to pull out data that’s going to help you benchmark where you are right now and compare that to the national model in the pilot states.

Obtain your 2019 baseline data. Determine what’s available from your EMR vendors. Find out what tools they have to extract or report your agency’s data. Can you actually use the data? Does it give you the benchmarks you need to determine where you need to improve? Plan how you will perform analytics and track performance improvement.

2. Establish opportunities for improvement

Analyze your outcomes trends. Are you trending positively or negatively? Perform a “root cause analysis” to determine why your trend is not where it should be.

Once you know where you stand, you can set some guidelines and goals for where you want to be in 2023. All agencies should strive for securing their reimbursement. If you don’t already meet the national percentile, it’s important to know where you’re falling short and to build strategies into your operations so you can show improvement year over year.

Realize this is now an annual competition. You’re not just striving to hit a static benchmark. The agencies that earn the highest reimbursement rate will be the highest performers (or “most improved”). Other agencies will be improving their quality, and you’ll need to keep up.

3. Know your strengths and accept referrals wisely

Under the HHVBP model, it’s becoming more important to make sure the patient is receiving the right care, at the right time, in the right setting. When you look at a referral, look beyond the initial revenue potential. Ultimately, you need to decide whether your home health agency can improve that patient’s quality of care.

When considering a referral, evaluate the following:

  • Whether you can improve the patient
  • Whether you can improve them more than other patients (matching your agencies’ strengths and resources to the care needs of the patient)
  • Whether they’re an appropriate candidate for home health (because they’re not likely to impact your rehospitalization or emergency department rate)

Consider chronic heart failure (CHF), for example. Do you do a good job of managing those patients? Can you determine if someone is in end stage CHF and therefore maybe not an appropriate home health candidate? Does your agency have a strong CHF program or care path in place to care for the patient’s needs in their home and avoid unnecessary hospital or emergency room visits? Perhaps this referral requires a different level of care than home health. Look at your strengths and where you can make the biggest impact on patients and accept referrals accordingly.

In the end, value-based payments will drive agencies to look more deeply at referrals, adjust performance pattern, and develop programs that will have a positive impact on the care you’re providing.

4. Pay attention to patient satisfaction

For large cohort agencies that use HHCAHPS data, those scores will account for 30% of your value-based payment calculations. 

Of course, we all know that patients who are dissatisfied with a service are more likely to complete an HHCAHPS survey. But there are things you can do to increase completion rates and scores across your entire population.

Strategies include educating the staff in how to talk to the patient that a survey may be received from and appreciate their feedback, using survey language in your person-to-person communication (e.g., “We want to be a 10. What do we have to do to be a 10?”) and providing in-home tools that increase patient recall of the service you provided to them.

5. Build OASIS proficiency

OASIS measures will be used to calculate 35% of value-based payment scores for large cohort home health agencies and 50% of scores for the small cohort. Accuracy in OASIS assessments can have a significant impact on your ratings. Few people like doing an OASIS assessment, but what goes in affects what goes out. Provide ongoing education and help staff understand the impact it can have on quality measures and value-based purchasing results.

Wipfli is ready to help your agency succeed in HHVBP

At Wipfli, we are ready to help you address these challenges and drive your agency to excellence. Contact a member of our specialized healthcare team today to get started. 

Wipfli’s home health specialists offer tools, educational resources and effective quality improvement solutions to set your agency up for success. Our new Home Health Referral Forecaster tool will help guide your agency to appropriate referral selection that best fit your agencies care strengths. We can help you:

  • Review and analyze your current base data
  • Develop QAPI/PI strategic plans to produce improvement
  • Perform financial analysis and quarterly tracking
  • Provide service with “Referral Analysis Tool” to maximize resources are control utilization
  • Provide efficient OASIS training

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Brian Lebanion, MBA, CPC, RNC
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