In July, CMS released a guide to new and updated frequently asked questions around the Home Health Value-Based Purchasing (HHVBP) model.
Yet while home-based care providers certainly have many excellent, technical questions, one sits above all others:
How will the expansion of HHVBP affect their reimbursement?
The good news: the answer lies more with providers than perhaps they realize.
Since CMS standardized it in 2018, Quality Assurance and Performance Improvement program, or QAPI, has served as a guiding light for home-based care providers. The program is the process by which a home-based care provider measures its quality metrics. If a provider knows they need to focus on reducing acute-care hospitalizations, for instance, QAPI can help them do so.
“That tells you what performance improvement measures you need to try in order to improve your hospitalization rate,” says J’non Griffin (HCS-D, COS-C, HCS-H, HCS-C), Principal of SVP Coding and OASIS at industry-leading post-acute care technology provider SimiTree. “I think a lot of agencies have kind of slacked off of their QAPI program. So it’s important to get that back into place and make an actually meaningful tool rather than just a requirement.”
Here is a look at three steps providers can take to improve their QAPI approach, fix their VBP scores and boost their Medicare payments.
- Identify your VBP fixes
With the new Interim Performance Reports (IPR) out as of the last week of July, providers have a much better look into where exactly they need to make improvements to shore up performance under VBP. Providers can use the reports, available for download from the Internet Quality Improvement and Evaluation System (iQIES), to measure themselves in the first half of 2023 against the second half of 2022, as well as against other home health agencies nationwide.
“With the IPRs, we’ll be able to tell where an agency is deficient,” Griffin says. “If they’re below the national standard, obviously we cannot work at everything at one time, so what is the lowest hanging fruit? Where are you closest to getting to the benchmark to have enough points to avoid a reduction in pay?”
That pay will be for 2025, based on 2023 performance.
“That seems like a little bit of delayed gratification or delayed penalty, but it just is,” Griffin says. “What we are doing today will affect the 2025 payment.”
- Put QAPI at the center of your fix process…
In addition to using QAPI to improve VBP scores, home health organizations can also use it to improve patient safety, reduce costs, and improve the overall quality of care. But how will they do it? Quite simply with the right expertise and programs in place.
Because CMS is comparing an agency’s 2023 performance metrics in certain key areas to national averages and benchmarks from the baseline year 2022 to create an overall VBP performance score, the score will impact Medicare payments with as much as a 5% increase or a 5% decrease. Tighter margins at agencies make that a significant amount.
To prepare, smart agencies are using QAPI to evaluate systems and processes, identify vulnerabilities and develop targeted strategies for improving performance in important areas. By using QAPI for this purpose, agencies ensure compliance with this important CoPs-mandated program and drive quality at the same time.
This makes it a highly effective approach.
“Every agency should be doing some form of performance improvement, some form of QAPI,” Griffin says. “What we’re suggesting is to concentrate on those areas that will get you to that next level in your IPR reports. So it could be dyspnea. It could be oral medications. It could be any of those things. But then you’ve identified it and you’re going to put a team together from your QAPI plan to focus on that outcome.”
- …and put your frontline workers at the forefront of your QAPI team
Frontline workers are essential to the success of any QAPI program. They have the most direct contact with patients and can provide valuable insights into how to improve care.
Griffin notes that the QAPI team should not just include the QAPI director and clinical manager, but also the people actually on the ground delivering care. Nurses, home health aides, therapists — even schedulers. They all have valuable insights to share about how to improve the care process in a given area.
The key to success with QAPI is to have a well-designed and implemented program that is supported by the entire organization.
“You kind of have to think outside of the box of making a visit, making a visit, making a visit, and instead making meaningful contact with the patient to try to prevent the problem,” she says. “You may have a triage team to make calls. It’s really going to depend on the size of the agency and what kind of capacity you have.”
For agencies that lack that capacity, outsourcing is another option.
“If you don’t have that manpower, you can outsource that piece — making the phone calls to the patient to ask about their shortness of breath,” she says. “QAPI outsourcing makes it even easier to realize the benefits of quality improvements without placing any additional burden on staff to conduct necessary monitoring and reporting.”
Striving to create a culture of quality is an important goal for home health organizations. An effective QAPI program can help create and maintain a quality-focused culture that reduces mistakes, improves patient care and drives better outcomes. QAPI can also help improve an agency’s star ratings, drive better referrals, help with retention efforts via higher staff satisfaction and provide a multitude of additional benefits.
The key, Griffin says, is that no matter your capacity, you push forward.
“You don’t give up on it,” she says. “You don’t just say, ‘I throw my hands up, we can’t fix this.’ You pivot to something else and then you monitor that. You have to trend it. You can’t just hope that it happens. Somebody has to trend it and that’s usually your QAPI team.”
This article is sponsored by SimiTree, which helps home health organizations understand how to improve performance scores under VBP, and can help agencies realize the benefits of quality improvements without placing any additional burden on staff to conduct necessary monitoring and reporting. To learn more about effectively using QAPI to address VBP, visit simitreehc.com.