Home Health Value-Based Purchasing (HHVBP) began this year in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington. As selected HHVBP states, all Medicare-certified home health agencies in these states are required to participate in the model, which studies the effects of incentives to improve quality and delivery of in-home services to Medicare beneficiaries. Agency performance in these states will determine if they will face an increase or potential decrease in payments beginning in 2018 through 2022. The potential adjustments begin at 3 percent in 2018 and increase to 8 percent in 2022. Payment adjustments will be based on each agency’s Total Performance Score, which is comprised of data from the OASIS, the CAHPS, and three new measures that must be self-reported.
| HHVBP Model Payment Adjustment Year | Possible Adjustment (Upward to Downward) Range |
| CY 2018 | 3% |
| CY 2019 | 5% |
| CY 2020 | 6% |
| CY2021 | 7% |
| CY2022 | 8% |
Agencies Organized Into Small and Large Cohorts For Analysis
When HHVBP was initiated, the model’s competing agencies were organized in small and large cohorts. The Small cohort group is comprised of agencies who are not required to participate in HHCAHPS because they care for fewer than 60 total unique patients in a calendar year. Large Cohort agencies are those certified agencies that have served 60 or more patients in a calendar year and must participate in HHCAHPS. Newly certified agencies (those who have been certified for less than six months and/or have less than 20 quality episodes) are not required to compete.
| No Payment Adjustment | Small Cohort | Large Cohort |
| Newly Certified agency:
In operation <6 months <20 quality episodes for at least 5 months
|
Agencies exempt from HHCAHPS:
< 60 total unduplicated patients served in a calendar year
|
Agencies required to participate in HHCAHPS:
60 or more unduplicated patients served in a calendar year |
In looking at data from the 2015 baseline year to establish quality point thresholds for the agency achievement and benchmarks measures, CMS noted that only three states (AZ, FL, and NE) in the HHVBP model had more than 10 agencies in the small cohort group, one state (IA) had 8-10 agencies in the small cohort group, and three states (NC, MA, and TN) had one-three agencies in the small cohort group. There were two states (MD and WA) that had no agencies in the small cohort group. CMS found that the small cohort had a higher variation rate because:
- The cohort is so small that there are not enough home health agencies (HHAs) to calculate the values using the finalized methodology (mean of the top docile), or
- The cohort is large enough to calculate the values using the finalized methodology, but there are not enough HHAs in the cohort to generate reliable values.
Benchmarks and Achievement Thresholds Calculated at the State Level
For the reasons above, CMS decided to calculate the benchmarks and achievement thresholds at the state level rather than at the smaller-and larger-volume cohort level for all model years, beginning with 2016. This change eliminates the increased variation caused by having few HHAs in the cohort but takes into consideration that some inter-state variations will be seen, due to state regulation differences. CMS also finalized that in states where there are fewer than eight HHAs, those agencies will be included in the large cohort for that state for the purposes of calculation of linear exchange function and payment adjustment percentages, beginning with the 2018 payment adjustment and thereafter.
Monitoring Data Is Important to Agency Success
Home health agencies in the HHVBP Model states know the importance of monitoring quality data. Knowing how you compare to competing agencies in your state, in real time, is key to performing well. Also important is a thorough understanding of your agency’s performance comparison from quarter to quarter, so that you know your business is continuously improving. Being able to understand your patient’s perception of their health care delivery is yet another insight that agencies cannot afford to ignore.
Axxess’ HHCAHPS Patient Engagement Platform enables agencies to monitor quality, patient engagement and delivers in-depth training on the quality measures and data sources used for Home Health Compare. This tool, when combined with the AgencyCore EHR platform, CASPER reports (derived from OASIS submission) and PEPPER Reports give you the real-time data needed to analyze and adjust business practices before the adjustments begin. Ask us about our solutions for HHVBP success.
