Home Health & Hospice Week

Turn this negative into a positive with preemptive action

Another sign that Medicare rushed the national adoption of the Expanded Home Health Value-Based Purchasing payment model is revealed in the program’s latest evaluation report on its forerunner, the nine-state HHVBP model.

Mostly, quality scores stayed stable under the six years of the VBP model that wrapped up in 2021, CMS says in a new Medicare Innovation Center report on the pilot. But “for the three composite [CAHPS] measures that rate professionalism, communication, and discussion of care by the agencies, we found that HHVBP was associated with a -0.3 to -0.5 percentage point relative decline,” the report reveals.

Specifically, those measures were How often the home health team gave care in a professional way (Professional Care); How well did the home health team communicate with patients (Communication); and Did the home health team discuss medicines, pain, and home safety with patients (Discussion of Care), the report explains.

All three factor into HHAs’ Total Performance Scores under VBP, as well as their Medicare compare star ratings.

CMS dismisses the change. “While unintended, this does not translate to an especially meaningful impact of HHVBP on these aspects of patient experience with care, given the high overall levels of performance on these measures (i.e., ranging from 82 percent to 89 percent),” the report maintains.

The drops in reported satisfaction weren’t seen in all pilot states, CMS adds. Florida and Massachusetts were “the drivers behind the unintended impacts for the HHCAHPS measures,” the report points out.

And for perspective, “the unadjusted values for all five [CAHPS] measures slightly declined between the baseline and post-HHVBP periods, with slightly larger declines of 0.2 to 1.2 percentage points in HHVBP states compared to declines of 0 to 0.8 percentage points in non-HHVBP states,” CMS avers.

Interestingly, “we found a statistically significant decline between the early years of the original HHVBP Model (i.e., 2016 – 2017) and the four most recent years where HHAs received a payment adjustment (i.e., 2018 – 2021) for these three measures,” CMS notes. That’s the opposite of what you might expect.

CMS further downplays the drop, noting “we would not expect a meaningful negative impact of HHVBP on patient experience with care based on our interviews with representatives of HHAs in HHVBP states where we heard that many agencies were identifying strategies to help staff improve agency response rates and scores on the HHCAHPS survey to improve their performance on these measures,” the report says. “The HHA survey we fielded this year … also found similar patterns between HHVBP and comparison states in approaches to quality improvement for the HHCAHPS-based measures,” CMS adds.

And other shifts such as “non-trivial changes to the HHVBP Model in 2019” and the COVID-19 pandemic may have played a part, CMS suggests. However, “our results do not point to a clear, sustained change in the effects of HHVBP on patient experience during the COVID-19 PHE,” the report allows.

Seize The Improvement Opportunity

While CMS is eager to give little weight to these hits to VBP agencies’ CAHPS scores in the report, National Association for Home Care & Hospice’s Mary Carr isn’t so sure.

She doesn’t necessarily buy CMS’ argument that they are “insignificant,” Carr tells AAPC. “It shows disparities,” she maintains. And “we’ll see greater disparities with two distinct cohorts” based on size in the national expanded model, she expects.

It’s too bad CMS didn’t take the time to investigate these findings before rolling out VBP nationwide. Medicare praises the nine-state model’s money-saving abilities, but “there are underlying cracks,” Carr warns. “It bears watching,” she stresses.

Meanwhile, the good news is that if the CAHPS scores lower for all agencies under VBP, then it won’t have a functional impact on performance under the expanded model, points out attorney Robert Markette Jr. with law firm Hall Render in Indianapolis.

Hidden opportunity: And the small hits to CAHPS scores may actually give your agency a chance at a competitive advantage, Markette suggests. “Anything you can do to improve your [Total Performance] Score a little bit will help,” he tells AAPC.