Through a popular internet trend, social media users have posted “how it started” versus “how it’s going” updates about their lives and relationships for more than a year. The idea is to share snapshots of the before and after of a significant event.

The Centers for Medicare and Medicaid Services (CMS) unveiled its own version of the before and after scenario in July, and it is likely to have a massive impact on home health agencies across the country.

How massive? Home health agencies could see an increase or decrease in payments of up to 5% based on quality measures.

How it started

What started in 2016 as a nine-state model to promote greater quality and efficiency of care among home healthcare agencies, the Home Health Value-Based Purchasing Model (HHVBP) soon could expand to all 50 states, U.S. territories and the District of Columbia next year, according to a CMS notice of a proposed rule in the July 7 Federal Register.

The HHVBP model rewards or penalizes providers based on performance. The expansion would make the model mandatory for Medicare-certified home health agencies nationwide. To date, the model has been piloted in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington for five-plus years.

How it’s going

In January, CMS announced that HHVBP has resulted in an average quality improvement score of 4.6% and an annual savings of $141 million to Medicare since the model began.

The new rule would go into effect Jan. 1, 2022, ending the nine-state model a full year earlier than planned. The proposed rule would make 2022 the first performance year of the nationwide implementation and 2024 the first payment year. That means home health agencies will need to make sure they have mapped out a plan to keep their quality outcomes on track.

What’s visible ahead

Since 1999, home health agencies have been required to collect and transmit Outcome and Assessment Information Set (OASIS) data to dictate payments. Now that data is being used differently.

Rather than merely paying for services, CMS is crowning quality as king under the new payment model.

This means it pays for agencies to be sure their clinicians are looking at patients holistically, their teams understand the impact of the new model, and their staff members have a high level of knowledge when it comes to OASIS coding and billing. In fact, if the expansion rule is finalized, it will make strong documentation from nurses — key to accurate coding — more important than ever.

According to the Federal Register, the proposed maximum payment adjustment for agencies would be 5% — upward or downward — based on quality measures, which is a departure from the proposed percentage in the nine-state pilot model. The original plan called for maximum adjustments of 5% in 2019, 6% in 2021, 7% in 2021, and 8% in 2022.

However, the Federal Register post pointed out that CMS “may make changes to the payment adjustment percentage through rulemaking in future years of the expansion.” Home health operators can comment on the proposed rule online via Regulations.gov until Aug. 27.

Determining quality

When quality measures start impacting reimbursements via a value-based payment model, continuously monitoring your patient outcomes is paramount. If your agency does a good job delivering high-quality services, you could get a bump in pay that smooths the financial road ahead. If not, you risk the opposite.

But what elements determine your quality rating? The rule proposes eight different measures for the expanded HHVBP:

  • Improvement in dyspnea
  • Discharged to community
  • Improvement in management of oral medication
  • Total normalized composite change in mobility
  • Total normalized composite change in self-care
  • Acute care hospitalization during the first 60 days of home health use
  • Emergency department use without hospitalization in the first 60 days of home health
  • Home Health Consumer Assessment Healthcare Providers and Systems (HHCAHPS) survey

In this model, some agencies can speed ahead and others will fall behind. However, agency operators are in control of the care they provide. In effect, that means keeping your vision focused on care quality can also give you more control over your reimbursement fate.

Regardless of your case mix or the types of patients you serve, your agency has the ability to succeed in this model. And with the razor-thin margins in home health, any increase or decrease really is critical.

Map out your strategy

One path to maintain and increase quality is simple — focus on competency management.

Granted, it’s easy to enroll everyone in the same training course and call it a day. If, instead, you examine individual and organizational education needs, your agency has a chance to thrive under the proposed model.

Managing competencies is an effective way to measure your organization’s capabilities and understand everyone’s strengths and weaknesses. With that knowledge, you can fight the complacency that leads to minimum skill sets and instead create a culture of professional growth.

Maintain your talent

Don’t forget that opportunities for growth fuel professional pride, confidence and loyalty.

Amid the coronavirus pandemic, recruiting, hiring and turnover complaints have been a common refrain. Naturally, continual turnover can have a damaging impact on the quality of care your agency can provide.

Along with a decrease in quality of care, research says turnover can put a strain on staff, require overtime and contract labor, and lead to low staff satisfaction.

Instead, consider the value of keeping your staff motivated by supporting improvements in their competency. That can help them see the satisfying payoffs in terms of patient outcomes. In turn, that boosts confidence and engagement.

From the value-based perspective, uncontrolled turnover can veer your agency toward quality deficits and then to deeper financial ruts.  

Pay attention to the markers CMS is posting with this HHVBP proposal. With quality at the wheel, you can keep your “how it’s going” updates moving in the right direction — toward a solid financial destination.

Don Spiers is a senior product manager at Relias, providing market insight on home health, hospice and home care.