Home Health & Hospice Week

Make sure your outcomes won't tie you to the tracks.

The details may still be under negotiation, but one thing is clear: Pay for performance will hit home care providers, and soon.

The rising cost of health care is driving payors, especially Medicare, to implement a payment system that rewards providers for quality care, Debbra Hattery, deputy director for the Centers for Medicare & Medicaid Services' Quality Measurement and Health Assessment Group, said Oct. 16.

"Pay for performance is an important part of us being able to improve quality," Hattery told a standing-room only crowd at the National Association for Home Care & Hospice's annual meeting in Baltimore. And home health agencies soon can look to CMS' home health P4P demonstration for clues on the final payment structure that will affect all providers.

P4P Demo Planning Underway

CMS began designing the P4P demonstration project this month, Hattery noted at the conference. Agencies' participation in the demo is expected to be voluntary and on a state-wide basis, she added.

But many demo details, as well as the final payment system, are up in the air, she conceded. For example, whether CMS will pay providers for hitting absolute benchmarks or improving on their own measures.

Also still under negotiation is how CMS will pay providers that excel under the system. It may take reimbursement from the bottom performers to give to the top, or may take money from all providers to redistribute to top achievers, for instance.

What you do know: Home health P4P will almost certainly employ agencies' OASIS-based outcomes they already use for outcome-based quality improvement, Hattery confirmed. Any measures used would display on Home Health Compare, Medicare's outcome comparison Web site.

The agency doesn't want to impose an additional reporting burden on agencies when a set of reliable data already exists. "CMS is in an excellent position" to reward providers based on their OASIS data, since the industry has been collecting it for so long already, she told attendees.

CMS will settle on outcomes that have been endorsed by the National Quality Forum, Hattery added. (For a list of NQF-endorsed measures, see Eli's HCW, Vol. XIV, No. 6).

What you don't know: It's unclear which OASIS-based measures will serve as the guinea pigs for P4P, Hattery noted. Providers have found some measures particularly problematic, but CMS is working on refining them, she pledged.

Heads up: And eventually, CMS probably will pay agencies for some process-based measures too, Hattery said.

CMS is waiting for Congress to direct it in home health P4P particulars, Hattery revealed. "We just don't know the answers to all those things yet," she said of the P4P details.A June 2007 report on P4P, required by last year's Deficit Reduction Act, will also shed further light on the system, she pointed out.

What To Do Now

In the meantime, HHAs should polish their outcomes in anticipation of their reimbursement impact, experts recommend.

Each state's Quality Improvement Organi-zation can help providers to boost their outcomes, urged Marian Essey, director of Health Care Quality Im-provement for QIO Quality Insights of Pennsylvania.

In addition to personalized help from your QIO, you can access many outcomes-enhancing re-sources and tools at www.MedQIC.org, Essey reminded listeners in the same session. "There are a lot of best practices on MedQIC," she stressed.

Watch out: As part of the QIOs' contract with CMS, they are working on improving certain outcomes for HHAs. For instance, 30 states are targeting acute care hospitalization, oral medication and pain and dyspnea measures, she reported.

That means you can expect the national average for those scores to increase, Essey predicted. The result -- the bar may rise higher when it comes to achieving scores to obtain P4P payment incentives.