Home Health & Hospice Week

Don't let this payment mechanism take you by surprise.

Your Medicare payments could be set by pay for performance soon, if policy- and lawmakers get their way.

The Centers for Medicare & Medicaid Services is readying a P4P demonstration for home health agencies. Congress is requiring HHAs to report quality data starting in January. And the Medicare Payment Advisory Commission is recommending quality measures for P4P (see Eli's HCW, Vol. XV, No. 13).

"P4P will be a force throughout the health care market," said Amanda Twiss, president of Seattle, WA-based benchmarking company Outcome Concept Systems, in a March 27 P4P presentation at the National Association for Home Care & Hospice's annual policy conference in Washington, DC.

Here are six tips Twiss offered attendees to succeed under P4P:

1. Educate yourself and staff. You can't pretend P4P isn't happening when it's right around the corner. While neither CMS nor Congress have laid out P4P details yet, there are plenty of basics HHAs management and staff should get to know, Twiss advised.

It looks likely that HHAs will start out with P4P based on the current home health quality improvement (HHQI) measures they already report, noted MedPAC analyst Sharon Bee Cheng in the same presentation. That's especially the case for the outcomes reported on Medicare's Home Health Compare Web site.

Strategy: Some agencies already are tying staff payment levels to certain quality measures to prepare them for life under P4P, Twiss noted.

2. Gauge your P4P standing today. Now's the time to assess how you're performing, so you can map out a plan to improve that performance if necessary. "Look at how you stack up compared to other agencies," Twiss recommended.

To prepare for P4P, agencies should reference national rather than regional numbers, Twiss added. That's because a nationwide P4P system will most likely be based on national statistics.

Tip: Take careful note of what types of patients you serve, Twiss counseled. With the shortcomings of the current risk adjustment system, different types of patients will affect your payments under P4P.

3. Implement disease management. The formula for success under P4P is very similar to the one for success with disease management programs, Twiss noted. Both focus on patients with chronic conditions, require patient compliance and process management.

If you can get a handle on successful DM, you're a long way toward succeeding with P4P. And starting with DM now is a way to be prepared when P4P finally hits, Twiss said.

4. Predict patients' outcomes. Under P4P, you'll have limited resources to get your patients' outcomes up to a certain level--or you'll lose money. Agencies should use the data they gather in a patient's assessment to predict potential outcome problems, and to direct resources to combat those potentially negative results, Twiss advised.

Most HHAs and their admitting clinicians already do this instinctively, using experience to predict when a patient is ripe for trouble such as a hospitalization or emergent care episode, Twiss acknowledged. Doing the same thing in "a more data-centered way" will help agencies and their patients steer clear of money-losing outcomes under P4P.

Armed with the predictive data, "providers can use DM and tailor interventions to directly impact the outcomes of patients most at risk," Twiss explained.

5. Make a P4P commitment. Your agency will only succeed at P4P if your organization--and especially your management--prioritize the issue, Twiss stressed. That includes setting out a defined improvement methodology, dedicating resources to the topic, and training staff.

Frontline staff won't focus on improving quality unless they are supported by their organization's overall commitment to quality, Twiss said.

6. Be proactive. Home care is just starting its journey into P4P. That means HHAs have a window of opportunity to help shape the coming payment system and incentives, Twiss emphasized. Be proactive in talking with CMS and other payors about how a P4P program should work, she urged.