Home Health & Hospice Week

Tip: Put some resources into quality improvement.

The timeline for a home health pay for performance system is hazy, but you can bet on its arrival, experts say.

The Centers for Medicare & Medicaid Services appears on board with the idea of a P4P system, now called Value-Based Purchasing (see related story, p. 138). "Implementation of a full scale home health VBP program will be a crucial next step in ongoing efforts to link payment to performance for home health services," CMS says in a report on home health VBP recently sent to Congress. "Home health VBP can help ensure that Medicare patients have access to timely, safe and effective home health services, protect the vulnerable home health population, and better allocate resources toward value."

On one hand: CMS can't whip a VBP system into place overnight. "A congressional mandate is needed in order for [a VBP system] to go into effect," notes financial expert Jim Hamilton with David-James in Baltimore.

"I would suspect that this is far enough down the road that folks should be worried about more pressing matters at the moment," suggests financial consultant Rick Ingber with VantaHealth Consulting in the Philadelphia area.

On the other hand: "I am sure CMS is proceeding with plans, so I am instructing our clients to ... start preparing," Hamilton tells Eli. "As an industry, we need to prepare for the worst and hope for the best."

HHAs can start by monitoring their Home Health Compare measures closely, Hamilton advises. That includes assessing their standing in comparison to their peers. And agencies should implement a quality improvement plan, Hamilton adds.

Many of consultant Tom Boyd's clients already focus sharply on their HH Compare scores, he reports. "While these will be a factor in P4P, the clients are more concerned today with competitive pressures and containing costs," says Boyd, with Rohnert Park, Calif.-based Boyd & Nicholas.

Adjust expectations: Don't look for a nationwide P4P system to closely resemble the demo, cautions financial consultant Pat Laff with Laff Associates in Hilton Head Island, S.C. "Demonstration participants had no downside," says Laff, pointing out that their rewards came from overall group savings rather than penalties for underperformers.

One concern industry veterans voice is that a P4P system will result in two tiers of home care providers -- those who strive for high quality care and receive payment bonuses, and those who accept lower payment and furnish lower quality care as a consequence. Implementing a P4P system than draws money from low performers is "short-sighted," Laff maintains.