Home Health & Hospice Week

Heads up: Sample reports are coming soon.

“It is imperative that if you have not been involved in Value-Based Purchasing through the demonstration, someone within your organization begins to unpeel the pieces to the process in understanding where your agency stands,” stresses consultant Melinda Gaboury with Healthcare Provider Solutions in Nashville, Tennessee. When the Centers for Medicare & Medicaid Services makes its VBP payment determinations, “you technically could be right at zero,” Gaboury acknowledges in her Monday Minute with Melinda vlog. “But it’s likely that you will have some positive to be added to your payments in future years or some negative to be taken away,” she warns.

“The value of preparation will affect reimbursement, as those agencies who perform above average will share in the savings up to a 5 percent maximum and those who perform below average will lose reimbursement up to 5 percent compared to similar sized agencies across the country,” reminds consulting firm Corridor on its website. “Take advantage of this pre-implementation year and prepare now,” the firm urges.

HHAs have many challenges coming up on VBP implementation, noted Irina Gorovaya with Amity Healthcare Group in a recent presentation for Accreditation Commission for Health Care University. Those range from limited staff and resources to support of quality improvement efforts to restrictions on utilization and payment imposed by alternative payment models or non-original-Medicare payers, Gorovaya said.

HHAs should attack VBP preparation on five fronts, Gorovaya suggested: staff training and education; data collection and analyses; Quality Assurance and Performance Improvement (QAPI) process; staff recruitment and retention; and technology.

For example: HHAs should consider increasing compensation for nurses with OASIS certification, Gorovaya encouraged.

HHAs embarking on the QI process should also pay close attention to the VBP details, advises wound imaging vendor Swift Medical. “Not all performance measures are weighted equally,” Swift points out. “Claims-based performance measures (i.e. hospitalizations) are weighted most heavily, meaning that any measure taken to reduce these costly events will significantly improve your agency’s performance,” the vendor notes.

In fact, the Acute Care Hospitalization accounts for 26.25 percent of an agency’s weight under VBP, while the next-highest measure is a three-way tie at 8.75 percent between the two Total Normalized Composite measures and the Emergency Department Use without Hospitalization measure. (See more details of which measures count for what in HCW by AAPC, Vol. XXXI, No. 17.)

“Wounds are the single greatest risk factor for home health hospitalizations, increasing the risk of hospitalization by 52 percent,” Swift Medical claims. That’s “more than any other diagnosis or factor,” the vendor emphasizes.

HHA staff may be confused that ACH and ED measures will matter next year, when the Home Health Quality Reporting Program is dropping them in favor of a Potentially Preventable Hospitalization (PPH) measure.

CMS has already issued a number of educational resources on its expanded VBP website including an overview webinar, a Model Guide, Frequently Asked Questions, and much more. Now the agency has added these new resources to the mix:

• An expanded HHVBP Model YouTube playlist that includes “podcasts, instructional videos, and on-demand recordings to help HHAs understand the expanded Model, as well as strategies for improving care delivery in home health,” CMS says.