In case you haven’t noticed, the Home Health Value-Based Purchasing (HHVBP) program is now nearing the three-year mark in nine pilot states: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee. The Centers for Medicare and Medicaid Services (CMS) launched the program January 1, 2016, modeling it after a similar Hospital Value-Based Purchasing program in an effort to save as much as $380 million annually by reducing unnecessary hospitalizations and skilled nursing facility usage.
At the heart of the Home Health Value-Based Purchasing program are 24 outcome and process measures that CMS will use to determine quality and corresponding rate adjustments – which start at 3%, but can rise to 8% by 2022, when the program is expected to be in full swing nationwide. Twenty-one of these measures were already included among existing home health agency reporting requirements, while three were entirely new measures that have never been reported before. All agencies in the nine pilot states are required to report these new measures, which include influenza vaccination of home health staff, herpes zoster (shingles) vaccines for home health agency patients, and advanced care planning for home health agency patients.
The 24 Outcome and Process Measures
Outcome Measures (15)
- Improvement in ambulation (OASIS)
- Improvement in bed transfer (OASIS)
- Improvement in bathing (OASIS)
- Improvement in dyspnea (OASIS)
- Discharged to community (OASIS)
- Acute care hospitalizations (Medicare Claims)
- Emergency department use without hospitalization (Medicare Claims)
- Improvement in pain interfering with activity (OASIS)
- Improvement in management of oral medications (OASIS)
- Prior functioning activities of daily living and instrumental activities of daily living (OASIS)
- Care of patients (HHCAHPS)
- Communication between providers and patients (HHCAHPS)
- Specific care issues (HHCAHPS)
- Overall rating (HHCAHPS)
- Willingness to recommend the agency (HHCAHPS)
- Care management/types and sources of assistance (OASIS)
Process Measures (9)
- Influenza vaccine data collection (OASIS)
- Influenza immunization received for current flu season (OASIS)
- Pneumococcal polysaccharide vaccine ever received (OASIS)
- Reason pneumococcal vaccine not received (???)
- Drug education on all medications provided to patient/caregiver (OASIS)
- Influenza vaccination of home health staff (Reported by HHAs through Web Portal)
- Herpes zoster (shingles) vaccine received (Reported by HHAs through Web Portal)
- Advanced care planning (Reported by HHAs through Web Portal)
To succeed under the new Home Health Value-Based Purchasing program, home health agencies must focus on 1) the accuracy of their OASIS data, 2) improvements in their OASIS data, and 3) improvements in their HHCAHPS scores. Launching and managing ongoing quality improvement programs aimed at improving OASIS and HHCAHPS results is important not only for the home health agencies in the nine pilot states, but also all other providers who will be absorbed into the program in a few years.
Can Telemonitoring Actually Reduce Hospitalizations?
One of CMS’s biggest aims of the HHVBP program us to reduce hospitalizations. If home health agencies don’t reduce the number of unplanned hospitalizations during the first 60 days of home health, then they stand to lose a substantial amount of revenue. It’s easy to dismiss the overall impact if the HHVBP hospitalization metric, as it is only one of 24 measures that comprise a home health agency’s Total Performance Score. That said, many of the other measures directly influence hospitalizations; the idea is that as a provider improves its outcome measures, then hospitalizations will improve as well.
For instance, issues in ambulation, bed transfer, bathing, dyspnea, pain management, medication compliance, ADLs, and IADLs – these are specific outcome measures included in an agency’s HHVBP Total Performance Score – all influence home health hospitalization rates.
Interestingly, these same measures can be improved through telemonitoring – or remote patient monitoring. A patient being remotely monitored by a care manager through telehealth technologies can receive immediate interventions before emerging issues become full-blown problems. This, in turn, can lead to improved outcome measures, reduced hospitalizations, and reduced E.D. visits. In fact, of the 21 existing measures that make up the vast majority of a provider’s HHVBP Total Performance Score, telemonitoring positively affects 15 of them.
Can telemonitoring actually reduce hospitalizations? The answer is a resounding yes.
Improvements Achieved by Advanced TeleHealth Solutions
Advanced TeleHealth Solutions provides customized technology, monitoring, and reporting expertise, without the cost of creating a new system, adding resources, or having start-up time involved. For home health agencies, our scalable remote patient monitoring service delivers timely, actionable data from patients’ homes, improving access and outcomes, while decreasing costs.
Our remote patient monitoring solution has dramatically reduced hospitalizations for our clients, including:
- 47% reduction for patients with CHF as a primary diagnosis
- 51% reduction for patients with COPD as a primary diagnosis
- 56% reduction for patients with diabetes as a primary diagnosis
- 63% reduction for patients with hypertension as a primary diagnosis
In a six-month CHF study, we achieved a six-month hospitalization reduction of 50% and a 30-day hospitalization reduction of 73%. But those aren’t the only benefits. Telemonitoring also reduces emergency care visits, improves timely and accurate patient information, improves patient outcomes, improves education and self-care, and increases efficiency and revenue. For home health agencies that are now financially at risk because of the Home Health Value-Based Purchasing program, these are all benefits that can be the difference between financial stability and financial crisis.
About Karen Thomas
Karen Thomas is a certified management accountant and the president of Advanced TeleHealth Solutions, one of the leading telehealth monitoring companies in the U.S. Karen is a nationally renowned speaker, a lecturer for Missouri State University’s graduate-level Health Care Administration program, and a contributing author to, “Home Telehealth: Connecting Care Within the Community,” published by Royal Society of Medicine Press Ltd. Karen has appeared on numerous webinars and has spoken at dozens of conferences on the benefits of remote patient monitoring, generating enhanced clinical outcomes, patient engagement, and coordination of care. She is a member of the Missouri Governors Innovation Task Force, a past board member of the National Association for Home Care and Private Duty Home Care Association, a member of the American Telemedicine Association and the American Society on Aging, and a past ex-officio member of the advisory board of HealthCare Technology Association of America.