Home Health & Hospice Week

These are the winners and losers under the Value-Based Purchasing proposal.

Except for a few tweaks, the Value-Based Purchasing model proposed in the 2016 rule follows the outline Medicare set out in the 2015 rule. It will reward or penalize agencies based on both achievement and improvement.

More details: The Centers for Medicare & Medicaid Services does specify the 29 outcomes it plans to use to calculate the outcome scores that will result in VBP adjustments (see story, p. 188). They include four new measures not previously reported by home health agencies.

For now, the new measures will be “report-only,” highlights attorney Robert Markette Jr. with Hall Render — you’ll get points based simply on whether or not you report them. But eventually, your scores for those measures will count, he cautions.

Delay Unlikely

An avalanche of comments from HHAs in the nine pilot states are likely to pour in, experts predict. But don’t expect arguments for a delay to persuade CMS officials.

CMS has been alerting providers of pending P4P/VBP since the mid to late 2000s, when it ran the first HH P4P demonstration, Laff points out.

And in last year’s rule, CMS explicitly stated 2016 as the timeline for its newest VBP model to start, Markette reminds agencies.

Winners: HHAs that will do well under VBP are those who have put processes in place to furnish high-quality care, and capture that quality with accurate OASIS reporting, believes financial expert Pat Laff with Laff Associates. Many agencies have been working on this issue for years.

Losers: Agencies that have failed to properly educate their staff on OASIS completion will pay the price under the VBP model, Laff predicts. “This is so critical, and people tried to do it on the cheap,” he observes. Such agencies’ outcomes data often don’t represent what really happened with the patient over the course of an episode, he says.

In addition to VBP, OASIS data also influences referrals via the new Home Health Compare star rating system for HH Compare, Markette points out.

Start VBP Prep, Either Way

For agencies in the nine states CMS has proposed, VBP prep is crucial, Laff says. If you’ve been working on your outcomes, continue the hard work. If not, jump in with both feet.

“Your quality scores are going to be huge” under the model, Markette stresses. The first nine states will see a “dramatic” impact.

Agencies outside of the nine proposed states should also get serious about VBP prep. For one, CMS may change its states in the final rule expected in November, experts note. Also, it’s not likely to be long before CMS takes the program nationwide, they predict.

Building a quality program that shows results will take time, Laff advises. Get started today if you haven’t already.

Take action: You have until Sept. 4 to submit comments on the rule. v

Note: To learn more about the 2016 HH PPS proposed rule’s details and impact, sign up for Robert Markette Jr.’s Eli-sponsored audioconference on the rule on July 13 at www.audioeducator.com/home-health/home-health-pps-2016-proposed-rule-07-13-2015.html.