Home Health & Hospice Week

Get ready for your improvement between 2019 and 2022 to get erased.

Have you been gearing up to tackle the Value-Based Purchasing payment model based on your comparisons to a 2019 baseline? If so, it will be back to the drawing board if the 2023 proposed payment rule gets finalized as-is.

Old way: In the training materials the Centers for Medicare & Medicaid Services has issued for VBP thus far, including its “HHVBP Model Expansion 101” webinar in February, it has designated calendar year 2019 as the baseline year for both individual HHAs (that were certified by then) and for the overall model.

New way: Now, CMS proposes to change the HHA baseline year from CY 2019 to CY 2022 for agencies certified by then, and for the model overall, the agency notes in its fact sheet about the rule.

CMS had considered using 2020 data for the baseline year, but judged it was too disrupted by the COVID-19 pandemic, according to previous rulemaking.

The change would “enable CMS to measure competing HHAs performance on benchmarks and achievement thresholds that are more current,” according to the proposed rule released June 17. “More recent data from the CY 2022 time period is more likely to be aligned with performance years’ data under the expanded Model, and provide a more appropriate baseline for assessing HHA improvement for all measures under the Model,” CMS maintains.

Another tweak is for agencies certified in 2022 or after. “We are also proposing that for any new HHA certified on or after January 1, 2022, the HHA baseline year is the first full calendar year of services beginning after the date of Medicare certification and the first performance year is the first full calendar year following the HHA baseline year,” CMS says.

The change would affect when agencies receive their benchmarks for comparison. “We understand that HHAs want to have time to examine their baseline data as soon as possible, and we stated that we anticipated making available baseline reports using the CY 2019 baseline year data in advance of the first performance year under the expanded Model (CY 2023),” CMS says in the rule. “If we were to finalize this proposal to instead use CY 2022 data for the HHA baseline year, we would intend to continue to make these baseline data available as soon as administratively possible, and would anticipate providing HHAs with their final individual improvement thresholds in the summer of CY 2023.”

Bumping that timeline by half a year would be OK, because “this would be consistent with the original HHVBP Model, for which improvement thresholds using CY 2015 data were made available HHAs in the first interim performance report (IPR) in the summer of the first performance year (CY 2016).”

CMS fails to mention in the rule that the first year of the original HHVBP Model had a lower level of reimbursement at stake than the expanded Model — 3 vs. 5 percent.

CMS considered not changing the baseline, or changing the baseline only for some measures (claims-based vs. OASIS, for example), the rule notes. But “this proposal would allow all eligible HHAs, starting with the CY 2023 performance year, to compete on a level playing field with all HHA baseline data being after the peak of the pandemic,” the agency argues.

For the Model baseline in particular, the change “would … allow the benchmarks and achievement thresholds to be set using data from after the most acute phase of the COVID-19 PHE, which we believe would provide a more appropriate basis for assessing performance under the expanded Model than the CY 2019 pre-PHE period,” CMS says.

This will be another point on which HHAs are likely to give Medicare officials an earful during the comment period.

The change “seems a little unfair, as agencies will not have their baseline year results until well into the first payment year,” points out consultant J’non Griffin with SimiTree.

Not receiving the threshold and benchmark data “until midway through the first performance year … appears to be a significant disadvantage,” agrees attorney Robert Markette Jr. with law firm Hall Render in Indianapolis.

“The baseline year change is unfortunate and may seriously impact what agencies were working toward, partic­ularly in achieving improvement from where they were in 2019,” criticizes consultant Angela Huff with FORVIS, the new firm formed by the merger of BKD and DHG. “This was supposed to be a ‘get ready’ year, and now the goal line has been moved while agencies are trying to prepare for this demonstration,” Huff says.