Home Health & Hospice Week

While home health agencies don’t have their own agency-specific Value-Based Purchasing data from Medicare, they do now have more guidance to help them figure out how they might perform under the model — and whether that will cost them.

On May 12, the Centers for Medicare & Medicaid Services announced that “the achievement thresholds and benchmarks for each quality measure in the expanded HHVBP Model are now available on the Internet Quality Improvement and Evaluation System (iQIES) portal: https://iqies.cms.gov/. The achievement thresholds and benchmarks were calculated by cohort using quality measure data for the Model baseline year, which is calendar year (CY) 2019 for the CY 2023 performance year/CY 2025 payment year.”

Reminder: “The achievement threshold is the median (50th percentile) of Medicare-certified HHAs’ performance scores on each quality measure during the designated Model baseline year (CY 2019), calculated separately for the larger- and smaller-volume cohorts,” CMS explains in its May HHVBP Newsletter issued May 16. “CMS uses the achievement threshold for calculating the achievement score,” the agency explains.

“The benchmark is the mean of the top decile (90th percentile) of all HHAs’ performance scores on the specified quality measure during the baseline year, also calculated separately for the larger- and smaller-volume cohorts,” CMS continues in the newsletter. “CMS uses the benchmark for calculating both the achievement score and the improvement score.”

HHAs can get more information on that calculation from another newly released resource, the Expanded HHVBP Model Guide.

Option 1: “An HHA with an HHA performance score greater than or equal to the benchmark receives the maximum of ten (10) points for achievement,” CMS explains in the guide released May 13.

Option 2: “An HHA with a HHA performance score greater than the achievement threshold (but below the benchmark) receives greater than zero (0) but less than ten (10) points for achievement (prior to rounding), by applying the achievement score formula,” CMS says. Under the achievement score formula, the achievement threshold is deducted from the agency’s performance score, then that result is divided by the benchmark minus the achievement threshold. That product is then multiplied by 10. (See the manual’s Appendix E for examples.)

Option 3: Finally, “an HHA with a HHA performance score that is less than or equal to the achievement threshold receives zero (0) points for achievement,” CMS details in the manual.

Remember, an agency’s Total Performance Score is calculated when an HHA receives a risk-adjusted HHA performance score for each measure during the performance year, as long as that measure has enough data. “The TPS is determined by weighting and summing each HHA’s achievement or improvement score (whichever score is higher) for each applicable measure,” the manual reviews. CMS adds up the scores for each measure to calculate the TPS, then the Linear Exchange Function (LEF) translates that into an agency’s VBP payment adjustment amount.

So, now HHAs can see what they will be aiming for on the achievement side.