Medicare Compliance & Reimbursement

IOM recommends measure including clinical outcomes, efficiency and patient centeredness.

The sooner the feds bring pay-for-performance (P4P) programs to home health agencies (HHAs), the better. So concludes a new report from the influential Institute of Medicine (IOM), a non-governmental advisory panel.

Positive results: P4P programs in hospitals are already saving Medicare money while improving care--and the same could be true in HHAs, the study suggests.

The report is noteworthy in two respects, observes Judy Adams of LarsonAllen in Chapel Hill, NC: It adds new support for the value of pay-for-performance to Medicare across the continuum of care and it calls for speedy implementation of P4P within the home health arena.

Prepare For Implementation Beginning 2009

The report, Rewarding Provider Performance: Aligning Incentives in Medicare (Pathways to Quality Health Care Series), calls on the Centers for Medicare & Medicaid Services (CMS) to begin P4P programs on existing measures "immediately" and to move toward "comprehensive performance assessment systems and sizeable reward during the next three years."

The IOM calls for CMS to implement P4P based on clinical quality standards in 2009 and for expanding P4P reimbursement to include patient-centeredness and efficiency measures by 2010. The timelines in the IOM report are likely to stand as "good target dates," says Adams, adding that "CMS is very interested" in moving forward on P4P.

Prepare Now For New Realities

To get your agency P4P-ready, begin to school managers and even field staff about how the new payment system is likely to reshape the way you do business, say the experts.

Basics: Keep in mind that P4P programs offer financial rewards to clinicians who provide care that meets certain standards or "measures" intended to gauge quality and cost-effectiveness. An estimated 30 million Americans are already enrolled in private health plans with P4P programs, reports the American Geriatrics Society.

For HHAs, the impact of P4P depends in large part on how P4P measures evolve, offers Ron Clitherow, senior manager for health care consultants Larson, Allen, Weshair & Co. in Charlotte, NC.

CMS has been discussing process measures that HHAs should report, but no one has yet developed the format to report additional data, says Adams. "Nor is there any full consensus on what key data should be submitted related to processes," she adds.

Likely: HHAs will probably start out with P4P based on the current home health quality improvement (HHQI) measures they already report, noted Sharon Bee Cheng, an analyst for the Medicare Payment Advisory Committee last March during the National Association for Home Care and Hospice's annual policy conference in Washington, DC. 

Vital concern: That may not be good news, many experts agree.

"Problems with Home Health Compare continue to raise questions about how much HHAs are truly able to impact outcomes in an environment in which the physicians and hospitals have a much bigger stake in controlling where patients will be treated," says Adams.

To stay in the game, agencies will have to monitor CMS' moves toward P4P closely. Only those who prepare now are likely to thrive, or even survive, during the transition.

Key to survival: The primary goals should be making care more cost-efficient while improving outcomes, reminds Adams.

Note: The report is available on the IOM Web site at www.iom.edu/CMS/2955.aspx.