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The Essential Guide to the Home Health Value-Based Purchasing Program (HHVBP)
On January 1, 2016, CMS launched the Home Health Value-Based Purchasing program (HHVBP) as a pilot in nine states – Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee. CMS estimates that the program, once fully implemented, will save $380 million annually by reducing unnecessary hospitalizations and skilled nursing facility usage.
Are you ready?
If you are a home health agency in one of those nine states, it is critical that you understanding not only the financial rewards and penalties associated with HHVBP, but also how to maximize your CMS reimbursements. Even if your agency is not included in the pilot, you should not simply ignore the program; use the pilot as an opportunity to learn and prepare because it is extremely likely that HHVBP will become a permanent part of CMS’s HHA reimbursement strategy.
What’s Inside “The Essential Guide to the Home Health Value-Based Purchasing Program (HHVBP)”
- Value-Based Purchasing Comes to Home Care
- The 24 Outcome and Process Measures
- The Total Performance Score
- Ongoing Improvement Scoring
- Transforming the Total Performance Score Into Payment Adjustments
- The Public Quality Report and Its Potential Impact
- How to Succeed Under Home Health Value-Based Purchasing (HHVBP)
- How to Use Remote Patient Monitoring to Maximize Payments
- Home Health Value-Based Purchasing (HHVBP) Definitions of Outcome and Process Measures
- Home Health Value-Based Purchasing (HHVBP) Frequently Asked Questions
A Sample Excerpt from “The Essential Guide”
The Hospital Value-Based Purchasing (VBP) program was established as part of the Affordable Care Act of 2010, with financial payments to hospitals being adjusted beginning in fiscal year 2013. VBP is the cornerstone of CMS’s long-standing effort to link Medicare’s payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting. In short, participating hospitals are paid for inpatient acute care services based on the quality of care, not just quantity of the services they provide.
Until now, home health providers have only been indirectly impacted by value-based purchasing, as hospitals and physicians, in many instances, have required home health agencies to achieve certain quality goals as part of obtaining referrals. As such, home health agencies that have not been able to demonstrate a positive impact on hospitals’ value-based purchasing objectives have seen referrals dwindle – if not disappear altogether.
With the home health value-based purchasing program (HHVBP), the need to achieve speciﬁed quality metrics will no longer be driven by the indirect pressure of referral sources, but also by the direct impact of CMS reimbursement. To wit: Home health agencies could see reimbursement shifts – either up or down – that start at 3% and rise to 8% by the end of the pilot, depending on their performance across 24 outcome and process measures established by CMS.
Moving away from fee for service in favor of a risk-sharing and outcomes-based reimbursement model is a major focus for CMS. In addition, like its hospital counterpart, the program is simple in design: achieve certain quality metrics and be financially rewarded; fail to achieve these metrics and be financially penalized. Despite the apparent simplicity of home health value-based purchasing (HHVBP), however, the difficulty for home health providers lies in their achievement of specified quality targets.
For home health agencies in the home health value-based purchasing pilot group, CMS will use 2015 as a baseline and providers will not realize the consequences of their 2016 performance until 2018. For providers who achieve financial rewards, the additional payments could offer relief from the multi-year reimbursement cuts mandated under the Affordable Care Act; that said, failure to achieve quality targets present a significant level of risk.
Even though the nine-state pilot is scheduled to run for seven years through December 31, 2022, home health agencies not part of the test program should not simply ignore it. With the likelihood that home health value-based purchasing will become a permanent fixture once the pilot concludes – and with the financial impact substantial – this is an opportunity for non-participating agencies to learn and prepare. By comparison, CMS’s hospital value-based purchasing program has reimbursement shifts of only 1.25% to 2%; the stiffer penalties being doled out to home health agencies is not to be taken lightly.
Whether a home health provider is in the nine-state pilot or not, the new strategic imperative is clearly to focus on data-driven performance models as a key to future success. Failure to adopt a data-driven approach to performance, quality, and outcomes today could be a home health agency’s financial undoing tomorrow.