Home Health & Hospice Week

Keep tabs on this payment experiment.

You don't need a crystal ball to see your pay for performance future--just take a look at the P4P demonstration project commencing in January.

The Centers for Medicare & Medicaid Services is set on eventually applying P4P to all provider types, include home health agencies, noted Henry Goldberg of Abt Associates in a Nov. 13 special Open Door Forum on the demo. Now is HHAs' chance to test P4P methodology and, hopefully, impact the program's ultimate form. Abt is CMS' P4P demo contractor.

New deadline: Demo enrollment was set to close Nov. 30, but CMS extended the deadline to Dec. 14, it said in the Nov. 28 home health Open Door Forum.

More than 1,700 Medicare-certified agencies in the seven demo states--Connecticut, Massachusetts, Alabama, Georgia, Tennessee, Illinois and California--are eligible to enroll, Goldberg told attendees of the Nov. 12 OASIS Certificate and Competency Board annual meeting in Baltimore.

However, CMS will place half of all enrollees in the demo's "control" group, meaning they won't be eligible for P4P rewards. That cuts the pool of potential P4P participants to about 850. Agencies will know they're in the treatment or control groups, so it's not blind like a drug trial, Goldberg explained in the forum that drew about 375 callers.

A "heavy stream of applications" was coming in during the days before the original due date, Goldberg tells Eli.

Tip: You need to fill out an application for each provider number you have, he instructed a caller. 30 Days Applies To Rewards, Not Outcomes Demo agencies will be eligible to receive a reward pool drawn from overall savings the Medicare program sees on those home care patients. For example, if the "treatment" group patients have lower hospitalization rates than the control group, the difference in overall hospital reimbursement for the patients will go into the reward pool.

Clarification: The demo will look at 30 days past discharge for reward pool purposes. But the patient outcomes used for the demo rankings will come from the episodes, not any time period after, Goldberg explained in response to an attendee question at the OCCB meeting.

And the Medicare costs are included in the P4P calculations whether they are related to the reason for home care or not, Goldberg clarified. Medicare care for reasons not related to home care should happen to both the treatment and control groups and "cancel each other out," he noted.

The demo is a risk-free way to try out P4P, Goldberg said in the forum. "The worst that happens is that you're not any better off and the best that happens is you are better off," Goldberg told the OCCB meeting.

A full 100 percent of the savings will go to the reward pool and demo [...]