Home Health & Hospice Week

More details unveiled in special forum this month.

You soon might get a peek at what pay for performance will look like for home health agencies.

The Centers for Medicare & Medicaid Services has begun the first phase of the home health P4P demonstration, which is slated to last from October 2006 until March 2009. And CMS will divulge details of the demo in a special open door forum Dec. 13.

The project will "apply P4P incentive payment methodology to a representative sample of Medicare home health agencies," CMS says in a summary of the project posted on its demonstration project Web site. The demo aims "to determine the impact of offering incentive payments to HHAs for improving the quality of care rendered to Medicare beneficiaries when such quality of care results in reduced need for additional services and, consequently, reduces cost."

The catch: The funding for this demo must come from "current spending levels," CMS says. That means CMS could reduce all agencies' reimbursement rates to go toward the P4P incentive pot.

An optional second phase of the demo could run from April 2009 through September 2010, depending upon funding availability, CMS says. The second phase would "entail ongoing monitoring of the demonstration, completing the collection and analysis of HH P4P data, determining final incentive payment amounts, and ensuring appropriate incentive payments have been made by the fiscal intermediary," according to the summary.

CMS and its P4P contractor, Abt Associates, seek industry input on the proposed demonstration design in the Dec. 13 forum, notes the National Association for Home Care & Hospice.

P4P Future In Doubt

Incoming House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) has said he doesn't necessarily support P4P programs. Medicare shouldn't pay anything for poor quality care, he maintains.

But the Government Accountability Office sent a Nov. 17 letter to Congressional leaders urging implementation of P4P programs. Congress should use Medicare reimbursement to reward quality and efficiency, the GAO recommended. The Medicare program's "size and complexity make it vulnerable to improper payments and inefficient payment systems," it said.     

Note: The summary is at www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/HHPP_Summary.pdf.