Home Health & Hospice Week

Jan. 1 start date holds, as CMS celebrates saving a million dollars with the program.

If you’re hoping the Expanded Home Health Value-Based Purchasing payment model will fizzle out after a year or two — don’t count on it.

A new report from the Center for Medicare and Medicaid Innovation, a division within the Centers for Medicare & Medicaid Services, shows why CMS has such high hopes — and long-range plans — for HH VBP.

When it was a nine-state model for five years, VBP saved Medicare $949 million, CMS estimates says in the Innovation Center’s Report to Congress released Dec. 12. “Since the inception of the CMS Innovation Center, six model tests have delivered statistically significant savings, net of any incentive or operational payments,” and VBP was one of them.

Moreover, quality increased for VBP agencies, the Innovation Center points out. “Total Performance Scores (TPS) … were 7.4 percent higher among HHAs in HHVBP states than HHAs in non-HHVBP states in 2020,” it says. “OASIS-based outcome measure scores (components of the TPS) for HHAs increased more in HHVBP states than in comparison states,” the report adds.

Flipside: VBP Comes With Quality Concerns

One drawback: The Innovation Center does admit that “two of five measures of patient experience with care declined slightly” under VBP. But “the model significantly reduced unplanned hospitalizations and improved beneficiaries’ functional status on five of six OASIS measures,” it counters.

A recent study published in the JAMA Health Forum backs up CMS’ praise of the program.

Unplanned hospitalizations decreased by 0.15 percentage points more in HHVBP states, says the study, “Association of the Home Health Value-Based Purchasing Model With Quality, Utilization, and Medicare Payments After the First 5 Years.”

The use of SNFs decreased by 0.34 percentage points more in HHVBP states, says the study led by Alyssa Pozniak with the Arbor Research Collaborative for Health in Ann Arbor, Michigan.

The savings generated, which the study puts at $190 million annually, were “primarily associated with reduced inpatient and SNF services,” the study notes.

Meanwhile, CMS is still on track for VBP to go live for its first performance year when the ball drops.

“During CY 2023, CMS will assess the performance of HHAs certified prior to January 1, 2022, to determine the payment adjustment amount applied during the first payment year, CY 2025,” CMS said in a Dec. 9 email message to providers.

Note: The 113-page Innovation Center Report to Congress is at https://innovation.cms.gov/data-and-reports/2022/rtc-2022. The JAMA study is at https://jamanetwork.com/journals/ jama-health-forum/fullarticle/2796639.