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Shift Towards Value Based Care

In the current fee-for-service model of reimbursing providers for health care, physicians and organizations have incentives to ‘do’ more. The more tests you order, patients you see, procedures you do, the more money you will make. This idea that prioritizes volume more than quality of care is precisely the reason why federal regulations are dissuading FFS payment models and are promoting value based purchasing (VBP) payment models instead. Under the new VBP model, HHAs will be accountable for both the cost and quality of care they provide. The VBP model is attempting to reduce inappropriate care while rewarding top-performing HHAs through public reporting, enhanced payments through differential reimbursement and increased market share through purchaser, payer and/or consumer selection. Even clinicians will require a new set of skills to assess patients in order to compliant with new federal regulations. Although, it is not clear exactly what CMS requires as new quality measures, the section below gives you a broad overview of what CMS is expecting.

How HHVBP Affects Your Agency

On July 10, 2015, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicaid & Medicare Services (CMS) proposed to move forward with the Home Health Value-Based Purchasing (HHVBP) Model pilot program in 2016. This pilot program is expected to capture the efficacy of quality-based incentive programs and hopes to reduce unwarranted hospitalizations and SNF usage, resulting in a cost savings of $380 million. CMS has run other similar programs with HVBP and Home Health Pay-for-Performance Demonstrations, which have given promising results, hence why they think HHVBP will increase quality of care for Medicare beneficiaries. The pilot program will affect nine states representing different geographic areas of the US (Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee) and Medicare certified agencies are required to participate in it.

Under this new program, CMS will determine payments based on a set of key quality measures and how agencies both achieve these targets as well as improve these targets. These measures include:

  • Clinical Quality of Care
  • Care Outcomes & Efficiency
  • Person/Caregiver Centered Experiences

Additionally, CMS has announced a new set of measures, which are taken in other care settings but are being implemented in the home health sector for the first time. These new areas include:

  • Advance Care Planning
  • Adverse Events Due to Improper Medication Administration and/or Side Effects
  • Influenza Vaccine Coverage for HHA Personnel
  • Shingles Vaccination Received by HHA Beneficiaries

HHAs will not be continuously measured on progress of the new topics, but rather need to submit documentation that proves that they have covered these services to receive points.

Not only do the quality measures change under the HHVBP program, but even an agency’s payment adjustments will go either up or down by 5% in the first 2 years, 6% change in year 3, and 8% change in the final two years. CY 2015 will be used as the baseline year for performance with CY 2016 performance measurement. Therefore, any payment adjustment consequences for CY 2016 will be present in their CY 2018 earnings. Furthermore, HHAs will receive 3 reports regarding their performance under HHVBP including:

  • Quarterly Performance Report
  • Annual Report Summarizing Payment Adjustments To Be Applied
  • Annual Performance Report

Another new element is that HHAs will only have 2 opportunities for requesting score recalculations

  • Within 10 days of the Quarterly Performance Report
  • Within 10 days of the Annual Performance Report

After this time window, no other requests for recalculations will be entertained by CMS. In conclusion, it is evident that CMS is planning on rather large changes in the way agencies run their day-to-day operations with the new value based purchasing model. Therefore, it is key that an agency runs as efficiently and compliantly as possible so as to ensure minimal repercussions.

KanTime is imagination realized. What do you imagine for your agency?