Home Health & Hospice Week

Strategy to be a top improver carries risks, expert warns.

Waste no time in getting to work on the Value-Based Purchasing measures, whether you’re in a VBP pilot state or not.

All home health agencies should have been hard at work on their outcomes since last year’s 2015 Home Health Prospective Payment System rule, when the Centers for Medicare & Medicaid Services announced it had targeted January 2016 as its VBP implementation date, says financial expert Pat Laff with Laff Associates in Hilton Head Island, S.C. “They told us,” Laff reminds. Hopefully, agencies have been monitoring their outcomes with real time data management software, Laff says. At the least, they should be analyzing their outcomes data available via Home Health Compare, “although that’s six months old,” he notes.

HHAs that waited to start their quality measure improvement programs until CMS released its 2016 HH PPS final rule will be fighting an uphill battle to avoid VBP penalties, Laff warns. (See details of the rule issued Oct. 30 in Eli’s HCW, Vol. XXIV, No. 39.)

“Providers in the pilot project states who are not prepared may find themselves receiving significant reductions in reimbursement,” cautions Indianapolis law firm Hall Render in analysis of the rule. All HHAs in the pilot states (Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee) are subject to the program.

Backfire: Some agencies may not have undertaken QI efforts, in hopes of making big strides once VBP was in place and securing bonus payments as a top improver. The program will compare data to a 2015 baseline.

But that could be a big mistake, Laff warns. Improving measures “is like turning a battleship, not a speedboat,” he says. Successful QI involves “culture and process changes,” Laff stresses. And “you need the right people in the right positions.”

Agencies in non-VBP states need to be just as concerned with their outcomes, experts urge. “Providers who are not in the pilot states should … be working on QAPI, but should also be closely monitoring the HHVBP program to measure its impact and identify strategies for surviving when HHVBP becomes the standard across the industry,” advises Hall Render.

Watch out: Your QI scores matter already, Laff emphasizes. Managed care organizations in certain areas are already using Home Health Compare rankings to decide which HHAs to partner with and how much to pay them. Top scorers can receive up to 105 percent of the episodic rate while bottom scorers can receive only 75 percent, Laff relates.