Home Health & Hospice Week

Critical: Are you checking your progress too late?

With mere weeks to go until the first expanded Home Health Value-Based Purchasing model goes live, it’s time to get laser-focused with your quality improvement efforts — and Medicare’s new PIPR can help your agency do it.

You can now access your Pre-Implementation Performance Report in iQIES, and see your agency’s preliminary cohort assignment, your value by VBP measure and that value’s ranking within the cohort, and four cohort data points for each measure — the 25th percentile, 50th percentile, 75th percentile, and mean of 90th percentile.

Reminder: The Centers for Medicare & Medicaid Services has “indicated that the 50th percentile indicated on the Measure Performance tab will be the preliminary achievement threshold and the mean of 90th percentile will be the preliminary benchmark threshold,” explains consulting director Charles Breznicky Jr. with SimiTree.

With the achievement and benchmark thresholds, “agencies can calculate a preliminary Total Performance Score with the data available,” Breznicky advises. (For details about that calculation, see Exhibit 10 in the Expanded HH VBP Model Guide at https://innovation.cms.gov/media/document/ hhvbp-exp-model-guide).

With PIPR data now available, follow this advice from the experts to make the most of it:

1. Get the lay of the VBP land. If you haven’t yet, review the basics of the VBP system and its scoring with the copious resources CMS has posted on the Expanded HH VBP webpage at https://innovation.cms.gov/innovation-models/expanded-home-health-value-based-purchasing-model. Then review the new instructional materials for the PIPR on that page.

“Get familiar with the terms and labels,” urges consultant Linda Scott of Scott Solutions in Arlington, Virginia.

Finally, “pull these reports” from iQIES, Breznicky counsels. Again, a link to instructions for downloading that report are on the model webpage.

2. Take a hard look at your data. “Once you have the report, review the Measure Performance tab, which will give the data collection period, agency score, percentile ranking and thresholds to reach the 25th, 50th, 75th and 90th percentiles,” Breznicky directs. “Review the measure value in each item to establish where you currently stand on each item,” he says.

“Applaud where you’re performing above your cohort” and “notice where you’re average,” Scott suggests.

Also: Providers should “evaluate their [PIPR] data in comparison to other VBP data sources they may have from vendors, to see how closely it correlates to what CMS is providing,” Huff offers. This will be key when you later monitor your VBP-focused quality improvement efforts.

3. Prioritize your QI efforts. With 12 different measures encompassing a wide array of factors, knowing where to start with quality improvement may seem a huge challenge. Your PIPR can help.

“The goal of providing HHAs with this preliminary data is to give an indication of where you should focus quality improvement efforts to furnish better care to beneficiaries, improve the agency’s TPS, and earn a positive payment adjustment within the Model,” CMS says in an introduction document for the report.

When reviewing the Percentile Ranking column in the Measure Performance tab in your PIPR, “those measures in which an agency’s ranking is in the <25 percentile or 25-49 percentile should be addressed first,” Breznicky recommends.

“Focus corrective action on what is most important in your organization — generally the worst-performing area,” Scott advises.

In addition to your ranking, you may want to consider which measures count for the most. For example, the Acute Care Hospitalization measure comprises 26.25 percent of your TPS, while the next-highest-counting measures — a three-way tie between the two TNC composite measures and the Emergency Department Use measure — count for a much lower 8.75 percent. (See chart with the TPS weight for each VBP measure, below).

“Rehospitalization reduction strategies should definitely be an area of focus for nearly every organization,” Huff emphasizes. “If agencies have not looked at ways to mitigate and have a solid process in place to prevent unnecessary hospitalizations, this is a key area to focus on before the end of the year,” she tells AAPC.

4. Set your QI goals. After narrowing down your focus areas, decide what you’re shooting for with them. “Establish goals for each measure,” Breznicky recommends.

CMS recommends using its “Quality Measure Category- Focused Performance Improvement” tool, available on the Expanded HH VBP Model webpage, to assist with this. “The tool walks you through two steps: profiling performance by measure category, and selecting improvement strategies matched to the opportunities for improvement identified. We recommend you check this resource out,” the agency says in the PIPR webinar.

If you’ve already set your goals, go back and look at them with this new data in mind, Huff exhorts. Fine-tune plans as needed before the VBP performance year launches.

Plus: “Be realistic,” Scott suggests. And “ask your staff,” she urges.

“Quality improvement around a specific series of metrics is a game of intensive, long-term, patient, and persistent focus,” Scott shares. “Understanding the data that drives these

measures will include looking at the behavior of your staff in collecting, reviewing, finalizing and transmitting the data,” she adds. “It also includes the behavior of staff with patients and how they influence responses/create experiences for patients.”

5. Educate staff. Your training job should be two-fold right now, experts suggest.

First, “share the PIPR report with field staff so they know where the agency stands at this time,” Breznicky advises. “Remember to be transparent with field staff on where you are currently, your targets, and actions being taken to meet those targets,” he says.

Second, you should educate staff on what you want them to do differently to achieve improved outcomes. To avoid overwhelming them, “it can be effective to provide small chunks of training, augmented by small incremental shifts in focus at care conference, daily/weekly reports, [and] communications,” Scott reflects.

“Finalize any education with your staff and make sure they know where your agency is focusing for VBP success,” Huff concludes.

6. Monitor your performance. You can keep tabs on your performance with future PIPR and, eventually, IPRs and APRs.

Bit waiting on data from CMS is not ideal, Huff stresses. “It will be critical that agencies have another source of solid data outside out of the PIPR to provide insight into how their agency is performing as close to real time as possible for each area, so that they can evaluate if their VBP performance plans are working or need to be adjusted,” she maintains.

“Agencies should know exactly where they are going to access the data they need and have set plans to monitor that data on a regular cadence before the end of the year, so they are not scrambling after VBP starts,” she adds.

7. Repeat — or not. When you get your results, “review any actions that were taken to improve outcomes, determine why they were or were not successful, and work to replicate any successes,” Breznicky counsels.

Sometimes your efforts may just need some tweaking, or sometimes you’ll have to go back to the drawing board entirely. “Persistence, full understanding, value, and watching for leading indicators — internal measures — so you can measure and monitor trends that will become the public results and competitive performance” is key, Scott advises.

8. Juggle priorities. “It is still really hard considering the multiple demands for agencies,” Scott acknowledges. Accordingly, “leadership functions” including “priority setting, resource allocation, focus, sponsorship, executive participation, [and] building this into to everyone’s performance goals … are going to be critical to success,” she says.

“OASIS-E kicking off at the same time will be another big change for organizations starting Jan. 1,” Huff allows. “But it will be imperative that agencies don’t lose sight of how their agency is performing in the VBP metrics that make up their total performance score, which don’t include any of the new items in OASIS-E,” she notes.

“VBP is a chance to really shine — or not,” Scott concludes. “This is a leadership challenge to be approached with courage, teamwork, commitment to using your data to help improve the care provided and the outcomes achieved.”