Home Health & Hospice Week

Quit moving the Value-Based Purchasing goalposts, commenters tell CMS.

Many home health agencies are just starting to get their feet under them when it comes to Value-Based Purchasing, and the last thing they need is for Medicare to shift the model’s ground — again.

Recap: In the 2024 home health proposed payment rule published in the July 10 Federal Register, the Centers for Medicare & Medicaid Services suggests two major categories of VBP changes — moving the model’s baseline year and swapping out five of the current VBP measures for three new ones effective January 2025 (see details in HHHW by AAPC, Vol. XXXII, No. 24-25).

The former proposal garnered virtually no support in the 900 comment letters submitted on the proposed rule, and a lot of strident opposition.

CMS already moved the baseline year up from 2019 to 2022 in last year’s rulemaking cycle, over much industry protest. “Changing the baseline year in effect moves the goalposts and negates improvements that have been observed between [calendar year] 2019 and CY 2022,” protests Keith Myers in UnitedHealth Group’s comment letter. (Myers was formerly CEO of LHC Group Inc. before its acquisition by UHG’s Optum division for $5.4 billion earlier this year. He is now a senior advisor for Optum, according to the comment letter.)

“This change in the base year used will result in agencies losing performance gains garnered under the prior baseline year measures,” Myers tells CMS. “Essentially agencies will be starting afresh on their quest for value-based performance,” he argues.

“These proposed changes devalue the great progress and focus we have made,” say multiple agencies nationwide, including Symbii Home Health and Hospice - Bear River, in a letter template.

“HHAs will have focused their quality improvement efforts for the first two performance years of the model based on results from 2022 data, then be back at square one with needing to reevaluate and revise their quality improvement efforts for quality measure scores based on 2023 data,” National Association for Home Care & Hospice staff say in the trade group’s 36-page comment letter. “CMS needs to appreciate the burden in terms of costs and resource use it will cause for HHAs to redirect the focus of their quality improvement programs,” NAHC exhorts.

“It is counterintuitive to CMS’ quality agenda to move the baseline year in this way,” insists Dan Savitt, CEO of VNS Health, formerly VNS-NY. “This only ‘rewards’ HHAs that have not focused on HHVBP quality measures over the last several years while penalizing HHAs that took initiative based on CMS’ directive to improve quality of care,” Savitt says in the agency’s comment letter.

“Moreover, moving the baseline year to 2023 means that agencies won’t receive baseline data until 2024 to then compare and optimize quality strategies accordingly,” Savitt points out.

“Home health agencies have spent significant resources on quality improvement efforts using 2022 data, and switching the baseline year at this point will require agencies to effectively star over re-analyzing quality data, adjusting improvement plans, resulting in further costs to HHAs in addition to costs already incurred,” stresses Kathy Messerli with the Minnesota Home Care Association in the trade group’s comment letter.

Bottom line: “The benefits of maintaining a stable and predictable HHVBP outweigh any incremental change to HHA performance measures that might be gained by changing the model base year,” UnitedHealth’s Myers tells CMS.

“We strenuously object to CMS moving the HHVBP baseline year again,” VNS’ Savitt emphasizes.

“We strongly urge CMS to keep the baseline year as is to allow some stability for agencies,” Messerli says.

CMS should “refrain from finalizing its proposal to change the baseline year,” Myers urges.

Note: The VBP provisions of the rule are on pp. 82-99 of the PDF file at www.govinfo.gov/content/pkg/FR-2023-07-10/pdf/2023-14044.pdf.