Home Health & Hospice Week

They may have squeezed out all the improvement they can already, for one.

Is previous experience under the limited Home Health Value-Based Purchasing payment model a help or a hindrance? That may depend on the home health agency, experts suggest.

Agencies operating in the nine VBP pilot states of Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee “have a leg up at this point,” believes consultant Pam Warmack with Clinic Connections in Ruston, Louisiana. “Having the experience in the program is a huge benefit.”

However, “the content of the program will be changing somewhat from the original model,” Warmack notes.

“The changes in the measures and cohorts add new elements for those agencies to understand and manage,” offers reimbursement expert M. Aaron Little with BKD in Springfield, Missouri.

Agencies that have competed in the pilot “have run the gauntlet already, so have a pretty good idea of what this looks like for their organizations,” acknowledges consultant Angela Huff, also with BKD. “But … it could be a potential pitfall if those agencies get complacent,” Huff warns. “They need to see where they are now with the changes and adjust accordingly,” she advises. “They do need to pay attention.”

Many pilot agencies succeeded based only on their improvement scores, suggests Sherri Parson with consulting firm McBee. “You can only do that so long until you are a higher performer competing under achievement versus improvement,” she warns. In other words, agencies that have maxed out their improvement scores will have to stack up against other agencies on the achievement side under expanded VBP, which may be more challenging.

This drawback faced by a number of pilot HHAs now is going to eventually become a problem for nearly everyone in the VBP program, expects attorney Robert Markette Jr. with Hall Render in Indianapolis. And if most agencies are eventually clustered together on scoring, “you could be a good performer and still get penalized,” Markette notes. “But that’s a years-down-the-road problem when everyone’s got their act together,” he admits.