Home Health & Hospice Week

For a clue as to what policy- and lawmakers may include in home health agencies' eventual valuebased purchasing plan, look no further than the pay for performance demonstration that ran in 2007 and 2008. The P4P program:

• included 567 agencies in seven states;
• used seven publicly reported outcomes with different weights for reimbursement -- incidence of acute care hospitalization (25 percent), incidence of any emergent care (15 percent), and improvement in bathing (10 percent), ambulation/ locomotion (10 percent), transferring (10 percent), urinary incontinence (10 percent), oral medications management (10 percent), and status of surgical wounds (10 percent);
• measured outcomes for the time the patient was on service and for 30 days after discharge;
• used 75 percent of the reward pool for top performers -- the top 20 percent;
• used 25 percent of the reward pool for top improvers (with a performance floor);
• paid individually for each measure used, not using a composite score;
• paid out $15.4 million in bonuses, although one of the four regions didn't receive bonuses because the treatment group didn't save Medicare money compared to the control group.

Bob Wardwell with the Visiting Nurse Associations of America hopes "there will be a gradual phase-in with a small impact [which will] grow to larger impacts as the years go by and refinements are made to the process," he tells Eli.

Warning: "I think CMS could easily misjudge how much a 'small' impact could be, so folks will need to keep watchful," Wardwell says.