Home Health & Hospice Week

Climb on board the P4P train to test and improve the coming payment structure.

You have one more reason to get serious about OASIS accuracy--the new pay for performance demonstration.

Under the prospective payment system refinements hitting Jan. 1, OASIS accuracy will affect reimbursement more than ever. And OASIS data will take center stage in the P4P demo set to begin in seven states at the same time.

A P4P structure for Medicare home health agency payments is inevitable, predicted Henry Goldberg with Abt Associates, the Centers for Medicare & Medicaid Services' contractor for the P4P demonstration project. The demo "is a chance to try it out before the [P4P] train arrives," Goldberg told attendees at an Oct. 9 session of the National Association for Home Care & Hospice's annual meeting in Denver.

If agencies don't participate in the demo and give CMS meaningful feedback, "Medicare will do its own thing," Goldberg cautioned.

HHAs' Plates Are Full

Now isn't the best timing for the P4P project, Goldberg admitted in the session. With major PPS refinement changes occurring at the same time, including OASIS form changes, many agencies will feel too overwhelmed to participate, he worried.

But there's not much choice about the demo's timing. "It's now or never," he said. "If we didn't do it now, who knows what they would come up with?"

Risk-free: And agencies risk nothing by signing up, Goldberg maintains. CMS won't cut participating agencies' payments to make up the potential reward pool, so there's no financial downside. And Medicare will use OASIS data and patient outcomes already collected, so there's no additional reporting or paperwork burden.

Industry representatives are urging agencies in the demo states--California, Alabama, Georgia, Tennessee, Illinois, Connecticut and Massachusetts--to climb on board the project.

"Agencies ... that volunteer to participate will play an important role in helping to ensure that any future P4P project accurately aligns payment incentives with quality home health care," NAHC says.

"We are encouraging our members to sign up," says Brian Ellsworth with the Connecticut Association for Home Care. "We were very pleased to be selected and ... I am hopeful that most agencies will sign up," Ellsworth tells Eli.

The Georgia Association for Home Health Agencies is also urging members to sign on. "We feel it will be to their benefit to participate," GAHHA's Judy Adams says.

"We see no downside and an upside in potential performance payments," agrees Joe Hafkenschiel with the California Association for Health Services at Home.

Odds are good: Because the demo will calculate winners separately for each region and each measure, agencies have "14 chances" to win--either as a top performer or top improver for each measure, Goldberg explained. In 2006, 61 percent of agencies would have scored extra cash in just the top performer category alone, Goldberg noted.

GAHHA and CAHSAH gave Abt a letter to include in those state's agencies' invitation packets encouraging agencies to volunteer, Adams and Hafkenschiel tell Eli.

HHAs in the demo regions should be receiving those invitation packets now. Goldberg noted in the session that the letters were ready to go upon final clearance of the project, which came on Oct. 11.

Work ahead: Agencies that choose to participate in the project will need to kick their quality improvement programs into gear if they hope to snag extra cash for one of the seven quality measures included, experts advise. And agencies will have to tighten up their policies and procedures for dealing with non-compliant patients, counsels Burtonsville, MD-based health care attorney Elizabeth Hogue.

Note: More information is at www.hhp4p.info.