Winter ’15
15
FEATURE
•
Affordable Care:
Reduce the cost
of quality health care for individuals,
families, employers and government.
The design of the proposed HHA VBP
program leveraged lessons learned from
previous efforts to improve quality and
reduce expenditure growth. Some of these
initiatives include the Nursing Home
Value-Based Purchasing Demonstration,
the Home Health Pay-for-Performance
Demonstration and other public and
private sector initiatives. By implementing
a VBP program for HHAs, quality
improvement and performance will, over
time, align with the National Quality
Strategy and other providers in the health
system, fostering a culture of shared
accountability for beneficiaries and quality
improvement, according to CMS.
CMS plans to build upon the existing
home health pay-for-reporting program to
develop a full-scale HHA VBP program. The
VBP implementation plan will be designed
to coordinate with current home health
requirements in an effort to minimize the
burden of implementing such a program. A
few of these current requirements include:
• Payments based on 60-day prospective
payment episodes
• Agency performance reporting systems
such as Home Health Compare
• Quality and Utilization Measures
obtained from Outcome and
Assessment Information Set (OASIS)
assessments and the Home Health
Consumer Assessment of Healthcare
Providers (HHCAHPS) surveys
John Olajide is President and CEO of Axxess, a
leading supplier of quality technology solutions for the
health care industry. Thank you to Axxess for being
a Platinum Sponsor of HCAF’s 2015 Winter Mini
Conference. For more information and to thank them
for their support, visit
CMS HAS IDENTIFIED THE FOLLOWING
KEY CONSIDERATIONS IN THE DESIGN AND
IMPLEMENTATION OF THE HHA VBP PROGRAM:
Continuous quality improvement
framework
should include a compre-
hensive set of quality measures that
directly reflect patient outcomes.
Measures such as those found in
peer-reviewed clinical literature, in
widespread use among states and
private stakeholders and as suggested
by the Measures Applications
Partnership may be considered to fill
any gaps in existing measures.
An enhanced data infrastructure
and validation process
would be a
compilation of complete and accurate
data sets to calculate performance
scores and subsequently distribute
payment incentives to HHAs.
Scoring rules for individual
measures
may evaluate attainment
and improvement of performance on
each measure. Attainment is the direct
calculation of the measure as the
relevant performance metric and reflects
a level of performance. Improvement
examines the change in attainment
between one measurement period and
the next.
A performance assessment and
evaluation model
will need to assess
achievements across all measures. A
composite score could serve as both
a summary of overall performance and
as a factor in determining the size of
a VBP payment. Relying solely on the
individual measure performance scores to
determine VBP payments is also possible.
Funding for the VBP program
could
be to continue the system currently in
place for home health pay-for-reporting,
where a portion of a provider’s annual
update is based on their compliance
in a previous year. Another option is
payment withholds from HHAs similar
to the hospital VBP program where
the payment withhold and payment
adjustment occur in the same year, or
result in a net adjustment.
Transparency and public reporting
of VBP program data will enable
beneficiaries and their families to make
informed decisions about their care.
It will also allow better understanding
of the care provided to compare care
across HHAs. Data would be posted on
the Home Health Compare website.
Coordination across Medicare
payment system will coordinate the
HHA VBP
program with existing VBP,
pay-for-reporting, quality monitoring
and public reporting systems. This will
eliminate payment and provider “silos,”
improve the quality of care and better
coordinate patient care transitions
between hospitals, HHAs and skilled
nursing facilities/nursing facilities.
There is still much work ahead to
determine the feasibility of implementing
an HHA VBP program. Meanwhile,
it will be important for home health
care agencies to consider adopting
innovative, integrated software solutions
now to improve efficiencies, accuracy
and patient outcomes and be better
prepared in the case of a mandated HHA
VBP program.
