Home Health & Hospice Week

PIPRs contain data that won’t be used for ‘real’ VBP, CMS cautions.

Watch out: Home health agencies won’t get 100 percent of the data they will rely on for expanded Home Health Value-Based Purchasing — including cohort assignments — in the new Pre-Implementation Performance Report.

Under VBP which starts Jan. 1, “your HHA’s cohort is determined by your HHA’s unique beneficiary count in CY 2021,” the Centers for Medicare & Medicaid Services explains in slides for an on-demand webinar about the new PIPR reports. “If your HHA’s cohort shows ‘N/A’ (Not Available) in this report, your HHA could not be assigned to a cohort and cohort information presented is based on the larger-volume cohort, which most HHAs fall into,” CMS says.

“Updates to your cohort assignment will appear in future reports as applicable,” CMS adds.

Reminder: In modeling based on 2019 data, about 93.5 percent of HHAs fell into the larger-volume cohort. The larger-volume group will have 60 or more unique beneficiaries in the calendar year prior to the performance year, while the smaller-volume group will have 59 or less (see HHHW, Vol. XXXI, No. 18).

But a somewhat tentative cohort assignment before VBP starts is probably better that no cohort info at all until mid-2023, which is what it sounded like HHAs would get in a VBP Frequently Asked Question set earlier this fall (see HHHW, Vol. XXXI, No. 35).

In general for all data in the report, “because of the varying availability of data for each measure category, all three PIPRs will include at least some CY 2021 performance data,” CMS explains in the webinar. But “it’s important to note that performance data from CY 2021 will not be used in the calculations for the first payment adjustment year, CY 2025, under the expanded HHVBP Model,” CMS stresses.

Instead, “the July 2023 Interim Performance Report will contain complete CY 2022 data for all measure types,” CMS clarifies.

Note: The webinar is at www.youtube.com/watch?v=ImC62lLe254.