With value-based purchasing (VBP) programs underway and new quality measures being considered, the home health industry is entering a new era, according to advisors from the Visiting Nurse Associations of America (VNAA).
As performance continues to be tied to reimbursements and financial incentives, home health agencies that are proactive about their quality improvement plans and can prove it with data will be better served in the VBP environment, industry experts said during a webinar by VNAA and the Alliance for Home Health Quality and Innovation.
“All of these things come together to create what I believe holds the possibility of a new era for what we are doing in home health care,” Barbara Muntz, RN, BSN, MTS, and senior advisor to Community Health Accreditation Partner (CHAP), said during the webinar.
CHAP is an organization that offers an accreditation process for home health, home care and other community-based organizations and service providers.
A New World Order at Home
Home health agencies in nine states are just getting used to the first VBP pilot program from the Centers for Medicare & Medicaid (CMS), which took effect on January 1, 2016. The program requires home health agencies to report quality measures and compete for increased Medicare payments for higher quality performance.
For the rest of the industry, the pilot program is an opportunity to observe performance improvement models.
“The guy who putts second goes to school on the guy who putts first,” Muntz said during the webinar. “Those of you who are in one of these nine states to launch the VBP pilot, the rest of us are able to watch and learn.”
However, VBP is not the only programming shift home health agencies are dealing with. Additional quality assurance and performance improvements measures proposed by CMS, as well as more services being tied to bundled payments, are part of a “great convergence” of how the delivery of home health care is changing, according to Muntz.
These delivery changes and reporting measures are stemming from CMS’s triple aim—improving the quality of care, improving health outcomes and reducing health care costs—and the national quality strategies that are being implemented.
Data-Driven Decision Making
There is no doubt that data is the crux of thriving in this system. And for home health agencies, reporting the right data and tracking performance can have a huge financial impact.
“Data are the tools we use to evaluate and improve care, make decisions, provide evidence of value,” Muntz said. “With VBP, now data are tied to your financial wellbeing.”
With new programs coming to pass, home health must report new measures and determine data strategies that can reflect performance improvement in innovative ways.
“In the world of health care, the use of medians or averages can really be a problem,” Muntz explained. “Averages don’t show variances, but patients don’t feel averages. They feel variances. Having a performance improvement program and choosing measurements that reduce negative variations is critical for patient outcomes and your success.”
CMS has focused some of its initiatives on specific patient groups, such as the bundled payment program for those who have undergone hip and knee replacement surgery. CMS is expected to roll out additional programs related to specific procedures and patient groups. Focusing on improving quality and reducing costs among the groups with the highest costs of care, or ‘hot spotters’, can have a positive effect overall, and could be a good strategy for home health agencies, according to Muntz.
“As we move into this value of health care arena, there is a lot of focus on the hot spotters in hospital care,” Muntz said. “If we focus on the patients that are really high risk, we are overall going to improve the value proposition, the value and cost, and lower our risk. …Focusing on that hot spotter group is a good approach.”
Translating Data to Agency Success
Another important arm of maintaining a successful home health agency amid the “great convergence” is keeping employees engaged in a changing environment. Implementing new performance models can take a toll on home health employees, who are often contracted workers.
“Employee engagement is tough when you have contracted employees,” Muntz said.
The role of quality assurance may once have been able to be conducted by a single nurse, but home health companies may need to increase their resources to ensure all the new quality measures are appropriated, Muntz said.
However, Muntz believes that data can also be leveraged to show the human conditions of quality improvements by bringing data points into a translatable story. She referred to a hospital initiative that aimed to save 100,000 lives through the direct actions of employees.
“They were able to translate actions taken in the hospital to how many lives were saved, and translate out for the staff member that those kinds of humanizing of the data to make it tell a story—that’s a real story of the impact of these activities—is one way to help engage them.”
Written by Amy Baxter