Home Health & Hospice Week

The new reimbursement mechanism will be here sooner than you think.

If you're ignoring the push for pay for performance in hopes that it will disappear, you're wasting valuable time you could be using to prepare for the inevitable.

So said Pamela Teenier, Gentiva Health Services' Assistant Vice President over Medicare operations, in an Oct. 25 session on P4P at the National Association for Home Care & Hospice's 24th annual meeting in Seattle.

The Medicare Payment Advisory Commission, powerful U.S. legislators and the Centers for Medicare & Medicaid Services are all calling for P4P systems for Medicare providers, Teenier told a packed crowd. "P4P is really getting a lot of attention," she said.

How it could work: Pending legislation calls for 1 percent of the market basket index inflation increase to go toward a quality pool for Medicare home care providers in 2008, and that would increase to 2 percent by 2012, Teenier reported.

CMS then would distribute the pool to the top performers--likely the top 10 or 20 percent. Lawmakers could even decide to reduce bottom performers' pay rates to add more to the quality pool, she warned.

Stopping P4P legislation doesn't equal a halt to the payment change. CMS has indicated it's willing to adopt P4P even without a legislative mandate to do so, Teenier related. "CMS truly wants to move forward with the P4P methodology," she stressed.

OBQI Offers Ready-Made P4P Measures

A final P4P methodology could take into account four types of measures: patient outcomes, processes, structures and patient satisfaction.
 
Home health agencies already are familiar with patient outcomes and patient satisfaction, Teenier pointed out. An example of processes could be performing a fall risk assessment for certain types of patients, while a structure example could be mandated timeframes for responding to referrals.

In the short term, home care P4P is most likely to focus on patient outcomes because a ready-made set already exists--outcome-based quality improvement (OBQI) measures, including the measures reported on Medicare's Home Health Compare Web site.

Get started: Agencies can get a head start on financial success under P4P by working on OBQI measures now, Teenier suggested. To show improvement by the 2007 implementation date, agencies will need to start their QI efforts very soon. "It may seem like it's far away ... but it's really not," she warned.

Even in the unlikely event that CMS ends up going with measures other than the OBQI ones, agencies will be used to the QI process and will be able to achieve outcomes improvement and success after working on their OBQI measures, she said.

"It's not too early to worry about P4P," Teenier emphasized to attendees.