Home Health & Hospice Week

Hospitalization metric is a shoe-in.

Value-Based Purchasing in home care is inevitable, so home care providers are going to have to get used to some sort of VBP system.

Commenters on the VBP proposal had plenty to say when it came to measures they disliked (see story, p. 276). But they also made some constructive suggestions on what should be included in the model.

The Centers for Medicare & Medicaid Services should focus on measures related to preventing adverse events, such as emergency department use, hospitalizations, and rehospitalizations, the Medicare Payment Advisory Commission recommended in its letter. It should also prioritize measures relating to changes in functional status.

CMS may want to consider “a smaller group of robust and shared metrics — such as reduced hospitalization and correct administration of oral medications in VBP,” urged Margaret Franckhauser of Central New Hampshire VNA & Hospice, in her letter. “These would mirror elements of other entities in the continuum of care and be better aligned with the IMPACT act and the desire for value across the board.”

A number of providers suggested starting with 10 measures. In fact, CMS could just use the 10 measures that comprise the current Home Health Compare star rating, UnityPoint at Home offered. That set “is already in play and has been vetted for the Triple Aim objectives,” said the health system in Iowa.

The National Association for Home Care & Hospice urged CMS to go back to the drawing board to figure out which measures should make it into the VBP starter set. “CMS should convene a VBP Measure Consensus Panel made up of home health clinical experts and other stakeholders to develop VBP measures that have broad-based support, relevance, and efficacy … prior to the implementation of any home health VBP program,” the trade group recommended.

Of course, such a process would set back VBP’s implementation date, NAHC acknowledged.

An alternative: If CMS doesn’t want to reduce the number of quality measures, it should at least weight the measures in accordance with their importance, suggested the Alliance for Home Health Quality and Innovation. Otherwise, “this expansive approach invites a scatter shot approach to quality improvement that is infeasible,” AHHQI said.