Home Health & Hospice Week

TPS isn’t binding yet, however.

With home health agencies nearly three-fourths done with their first Home Health Value-Based Purchasing performance year, they soon will get more official information on how their pay will be affected come 2025.

Just how much of the reimbursement picture will HHAs see in their forthcoming October Interim Performance Reports? A newly issued VBP Frequently Asked Question addresses that issue.

The IPRs include “an interim Total Performance Score (TPS) allowing HHAs to track performance based on available data,” CMS explains in new FAQ Q6025. “HHAs can also see where their TPS currently ranks in comparison to other HHAs in their cohort.”

But the interim score shouldn’t make agencies feel too good — or bad — about their final pay rate for 2025. Remember, although your agency is nearing the finish line of the 2023 PY, the data in the October IPR only goes through March for claims- and CAHPS-based VBP measures and June for OASIS-based measures (see story, p. 270).

“A final TPS will not be available for the calendar year (CY) 2023 performance year until August 2024, in the Annual Performance Report (APR),” CMS explains. “The APR will include performance data for all 12 months of CY 2023,” the agency elaborates.

Pointer: “HHAs must have sufficient data for at least five (5) of the 12 quality measures to receive a TPS,” CMS reminds agencies in the FAQ.

CMS also offers some guidance on how to use the interim TPS in another new FAQ. “On the Measures Scorecard Tab, the value in the Percentile Ranking within Your HHA’s Cohort compares the home health agency’s (HHA’s) ranking to all agencies in the cohort, expressed in quartiles, as cited in footnote ‘c’ in the Interim Performance Report (IPR),” CMS explains in FAQ Q6026. “The TPS Statistics for Your HHA’s Cohort table provides a breakdown of percentile rankings within the cohort.”

Keep in mind: “When reviewing your individual data on the summary page [of the IPR], you’ll notice your Total Performance Score’s percentile ranking,” reimbursement expert Melinda Gaboury with Healthcare Provider Solutions in Nashville, Tenn., explains in her Monday Minute with Melinda vlog. “It could be less than 25th percentile, between 25th and 49th percentile, at the 50th percentile, 75th percentile, or even 99th percentile,” Gaboury details.

“To achieve a favorable outcome in the reimbursement impact calculation, your ranking needs to be at the 51st percentile or higher,” Gaboury emphasizes. “Therefore, if you currently rank below the 51st percentile, it’s crucial to focus on improving the areas that contribute to a low performance measure calculation. This way, you can boost your scores for the remainder of this year,” she explains.

Remember: “The TPS statistics shown in the Measure Scorecard Tab of the IPRs are provided for information purposes only and are not used in payment adjustment calculations,” CMS tells providers in the FAQ.

Note: The FAQs are at www.cms.gov/priorities/innovation/media/document/hhvbp-exp-faqs.