Home Health & Hospice Week

Know your TNC from your TPS, or you may be SOL.

You might have your home health-related vocabulary perfected from ADL to ZPIC, but the Expanded Home Health Value-Based Purchasing Model is set to bring a fresh new crop of terms to home health agencies this year.

Read on for the new definitions you should be getting to know sooner rather than later:

Pre-implementation year: The year in which the Centers for Medicare & Medicaid Services educates agencies about, and agencies prepare for, VBP. HHAs are currently in that year, 2022.

Performance year: The year in which HHAs’ performance data is collected. The first VBP performance year is 2023.

Payment year: The year in which HHAs’ performance data determines their payment adjustment. The first VBP payment year is 2025, based on data from performance year 2023.

Cohort: The group of HHAs that compete. CMS will designate a larger-size and smaller-size cohort nationwide in 2023.

Total Normalized Composite (TNC) quality measures: Composite QMs used as two of 12 measures for VBP. TNC Change in Self-Care includes data from Improvement in Grooming (M1800), Improvement in Upper Body Dressing (M1810), Improvement in Lower Body Dressing (M1820), Improvement in Bathing (M1830), Improvement in Toileting Hygiene (M1845), and Improvement in Eating (M1870). TNC Change in Mobility includes data from Improvement in Toilet Transferring (M1840), Improvement in Bed Transferring (M1850), and Improvement in Ambulation/Locomotion (M1860)

Total Performance Score (TPS): The numeric score for each qualifying HHA, ranging from 0 to 100, based on the weighted sum of the performance scores for each applicable VBP quality measure. Determined by weighting and summing the higher of the HHA’s achievement or improvement score for each applicable measure.

Model baseline year: The year used to determine benchmarks and achievement thresholds by measure for a cohort. That year is currently 2019 for HHVBP.

HHA baseline year: The year used to determine HHA improvement thresholds by measure. That year is currently 2019, with exceptions for agencies certified after that time period or for measures that don’t meet volume thresholds.

Achievement threshold: The median (50th percentile) of Medicare-certified HHAs’ performance on each quality measure during the baseline year, calculated separately for the larger and smaller-volume cohorts.

Benchmark: The mean of the top decile (90th percentile) of all HHAs’ performance scores on a quality measure during the baseline year, calculated separately for the larger- and smaller-volume cohorts. Used to calculate both the achievement score and the improvement score.

Improvement threshold: An individual competing HHA’s performance on a measure during the agency’s baseline year.

Linear Exchange Function (LEF): The method CMS uses to translate the TPS into a corresponding payment adjustment percentage. “The LEF is designed so the majority of the payment adjustment percentages fall closer to the median and a smaller percentage of HHAs will have the highest or lowest level of payment adjustments,” CMS noted in its “HHVBP Model Expansion 101” webinar in February.

Interim Performance Report (IPR): Quarterly reports issued in iQIES containing performance data from the most recent 12 months. Includes TPS update, a “scorecard,” and percentile rankings in comparison to others in its cohort. CMS issues two versions — preliminary and final — starting in July 2023.