Home Health & Hospice Week

Set priorities and benchmarks to guide your quality improvement efforts.

Whether you are in a Value-Based Purchasing pilot state or not, it’s time to get cracking on VBP preparation.

The VBP model begins for all home health agencies in nine states in a few short weeks, although the payment impact won’t be felt until 2018. It’s critical for agencies in those states (Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee) to gear up as quickly as possible. But agencies in other states need to get their VBP engines running as well. Why? “The cultural shift and focus on results must start as soon as possible,” stresses Bobby Lolley with the Home Care Association of Florida.

“There is no way around it, quality takes time and time will have to be invested at each and every step in this process.”

HHAs nationwide should consider these steps to increase their chance of success under VBP:

1. Register. In VBP states, agencies “need to follow the straightforward steps of … establishing their agencies’ HHVBP point of contact and obtaining a user account on the CMS portal,” Lolley advises.

A Dec. 17 Open Door Forum presentation by CMS takes agencies through the process step by step. See the instructions in the slides at https://innovation.cms.gov/Files/slides/hhvbp-odf-homehealthagencies.pdf.

All agencies in the nine pilot states must report three new VBP measures via the portal starting in October for the July-September period.

Agencies in non-VBP states don’t yet have to report the measures, which are Influenza Vaccination Coverage for Home Health Care Personnel; Herpes zoster (Shingles) vaccination: Has the patient ever received the shingles vaccination; and Advanced Care Plan.

2. Seek out education and training. HHAs need to be “getting as much information as they can on VBP,” Lolley urges. CMS and its VBP contractor The Lewin Group is providing the Dec. 17 Open Door Forum, and more training going forward. CMS and Lewin will establish a “HHVBP Connect” website that will contain webinar recordings and materials; newsletters; FAQs; and “a chat function that will allow HHA’s to share,” CMS says in its ODF slides.

Agencies should “learn all of the details that are available about the program,” agrees Ann Horton with the Maryland-National Capital Homecare Association.

“Participating in both the educational programs being conducted by CMS, their respective state associations and our valued industry partners is a great start,” says Marie Fredette of the Arizona Association for Home Care.

“The state executives in the 9 [pilot] states are coordinating closely, evaluating the various training programs available, and partnering to bring their members only the most credible information,” says Horton, who urges state association membership.

3. Train your staff. Once you have a handle on the program basics, it’s time to educate your staff whose assessments and practices will be determining your VBP scores. You’ll need to get “staff on board to understand the immediate and long term implications,” counsels Pat Kelleher with the Home Care Alliance of Massachusetts.

4. Set priorities. With 24 measures in play, HHAs will have to narrow their focus to improve their scores, Kelleher believes. Decide which priorities will receive the lion’s share of your resources.

Tip: Look to your star ratings and Home Health CAHPS data to help determine your focus, she advises.

But beware, the scores CMS uses on Home Health Compare won’t be exactly the same as those used for VBP due to population differences, Lolley warns (see story, p. 346). Make sure you understand the scoring methodology, Fredette urges.

5. Establish internal benchmarks. CMS isn’t providing benchmarks ahead of time that determine when HHAs will receive a reward, a penalty, or stay even under the program. You’ll need to figure those out for yourself as the program launches, Kelleher notes. And if pilot agencies bet wrong, they could lose up to 3 percent of their reimbursement in 2018. Agencies in other states likely won’t be far behind, since CMS is eager to ramp up VBP as quickly as possible. Experts estimate it could go nationwide within a few years.

Again, your star ratings and HH CAHPS info can help guide you, experts recommend.

But that won’t be enough. “It will be critical that CMS provides agencies with a more transparent and deliberate way to evaluate their own performance and how they compare to others,” Lolley tells Eli.

6. Nail down your quality improvement P&P. “Ensure your agency has a method/structure for utilizing the data gleaned … to guide performance improvement efforts,” Fredette says.

7. Make haste. There’s no time to waste in setting your VBP plans in motion. “CMS has released this pilot so quickly and have still yet to release information on the population they are looking at when evaluating performance,” Lolley criticizes. “This leaves providers with a very short window to gather their agency’s data, know what they need to improve, make process changes, and implement all of the strategies they need to thrive under a new payment system.”

Bottom line: “In the end, CMS rushed the rollout of this initiative and sadly providers will pay the highest price for their lack of planning,” Lolley fears.

HHAs not yet under VBP should use this head start to get a jump on all these necessary and time-consuming steps, experts urge.