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CMS Provides Presentation on Expanded Home Health Value-Based Purchasing

On Oct. 11th, the Centers for Medicare and Medicaid Services (CMS) provided an encore presentation of an overview of the expanded Home Health Value-Based Purchasing (HHVBP) program's Interim Performance Reports (IPRs) and Annual Performance Report (APR). The reports are critical to understanding and ensuring adequate payment for home health agencies (HHAs) as the new expanded HHVBP program begins implementation in January 2023. Performance measures count starting Jan. 1, 2023. Data from the Outcome and Assessment Information Set (OASIS), completed Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys, and claims-based measures are used to calculate HHAs’ performance. In a payment year, an applicable percentage ranging from negative 5 percent to 5 percent is applied toward Medicare fee-for-service payments.

The IPRs:

  • Will be published quarterly – first one in July 2023
  • Will be based on quality measure performance to the HHA based on most recent 12 months
  • Allow agencies to assess and track performance
  • Allow for strategic planning of quality initiatives

The APR: 

  • Will be published annually – first one in August 2024
  • Will be based on quality measure performance to the HHA based on most recent 12 months of a performance year
  • Presents an HHA's annual payment adjustment for the following calendar year and how it was determined relative to the Total Performance Score (TPS)
  • First performance year is January 2023
  • HHAs will not be assessed on their 2022 measures. The first payment year is 2025.

Relevant quality measures include the following:

OASIS-based:

  • Improvement in Dyspnea/Dyspnea
  • Discharged to Community
  • Improvement in Management of Oral Medications/Oral Medications
  • Total Normalized Composite (TNC) Change in Self-Care/TNC Self-Care
  • TNC Change in Mobility/TNC Mobility

Claims-based:

  • Acute Care Hospitalization (ACH) During the First 60 Days of Home Health Use/ACH
  • Emergency Department (ED) Use without Hospitalization During the First 60 Days of Home Health/ED Use

HHCAHPS Survey-based:

  • Care of Patients/Professional Care
  • Communications between Providers and Patients/Communication
  • Specific Care Issues/Team Discussion
  • Overall Rating of Home Health Care/Overall Rating
  • Willingness to Recommend the Agency/Willing to Recommend

The presentation provided the following: 

  • an overview of both IPR and APR reports
  • an overview of the Achievement Report, which compares an HHA's performance to that of its peers
  • an overview of the Improvement Report, which compares an agency to past performance
  • Care Points overview
  • overview of the Measure Scorecard – the sum of weighted Care Points to provide the HHA's TPS
  • TNC Change Reference – an HHA's performance on individual OASIS items composing the TNC Change measures
  • an overview of the Annual Payment Adjustment

The first IPRs will be available in July 2023, which is the first time a full year of measures will be available.

Members can direct questions to HHVBPquestions@lewin.com. Be sure to include your name and the HHA's name and CMS Certification Number (CCN).

Slides from the August presentation are available here, the August questions and answers (Q&As) are here, and the August recording is here.

For assistance in accessing reports in the Internet Quality Improvement and Evaluation System (iQIES), please email iQIES@cms.hhs.gov or call 1-800-339-9313. Additional information is also on the iQIES Help webpage.

Members should review the CMS expanded HHVBP Model pagewhich provides Frequently Asked Questions (FAQs), a model guide for the program, model reports, newsletters from December 2021 through September 2022, an overview of the quality measures, and more. Subscribe to the listserv to stay up to date.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871