CMS Fields Questions on Value Based Purchasing

The time has arrived for the implementation of newly proposed Medicare payment policies, and home health agencies large and small affected by one in particular now have a resource aimed at thwarting any confusion.

The home health value based purchasing pilot program (HHVBP) is officially underway in nine states as of Jan. 1, and the Centers for Medicare & Medicaid Services (CMS) released guidelines to direct agencies providing services in the selected areas. As such, all Medicare-certified home health agencies providing services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington will compete to receive increased Medicare payments for higher quality performance.

Under the program, different quality measures will be assessed to calculate a total performance score for the HHVBP model. For an agency to receive a score on a measure, it must have a minimum of 20 home health episodes of care for that particular measure, according to CMS. An agency won’t see payments adjusted until they generate scores on five or more measures.

Issues that CMS addressed in its first Frequently Asked Questions on the HHVBP model include:

  • Measures: Measures evaluated based on the Outcome and Assessment Information Set (OASIS) will be calculated using the OASIS assessments from Medicare fee-for-service, Medicare Advantage, Medicaid fee-for-service, and Medicaid Managed care and will be risk-adjusted to include factors like the payer for the episode, among others. Claim-based measures are based on the Medicare fee-for-service population and are risk-adjusted to incorporate five categories, including prior care setting, demographic, health status, Medicare enrollment status and interaction terms. Responses from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey will be incorporated, as well. Finally, new measures are specific to the HHVBP model, with an example being flu vaccine taken by employees.
  • Data Submission: Home health agencies are already reporting the majority of data under scrutiny in the HHVBP model through OASIS. Otherwise, there are two measures that are claims-based, five from HHCAHPS and three new measures to be reported specifically for the program on a quarterly basis beginning in October. Agencies must register as soon as possible for the HHVBP Secure Portal in order to submit the necessary data on the new measures. They can choose not to report such data, but if they don’t, they can only earn up to 90% of the total possible points for their total performance score.
  • Scoring: Benchmarks and achievement thresholds for OASIS measures will be available in April 2016 and for the HHCAHPS and claims measures by July 2016. Since these are based on industry averages, preliminary benchmarks and achievement thresholds will likely be based on data for 2013 and 2014. Also important to note is that only measures that have values will be factored into the total performance score.
  • Payments: The HHVBP program’s payment adjustments will only be applied to home health prospective payment system claims for Medicare fee-for-service beneficiaries. The first adjustment will take place in January 2018 based on 2016 scores.

Written by Kourtney Liepelt