In a recent Federal Register final rule, CMS finalized including all Medicare-certified home health agencies (HHAs) in an HH VBP (value-based purchasing) Model.
CMS had proposed starting with CY2022 for CY2024 payment, however, as a result of feedback during the public comment period, they decided to instead move forward with CY2023 as the first performance year (using CY2019 as a baseline year), with CY2025 as the first payment year.
Instead, CY2022 will be used as a pre-implementation year, with a 0% payment adjustment risk. CMS will use this time to provide technical assistance to HHAs to make sure they understand the implications of the VBP model.
Beginning with CY2023, the model will have a maximum payment adjustment of ±5%, with average performance compared to other HHAs in their cohort receiving no adjustment. Placement into two cohorts will be determined by the number of completed HHCAHPS surveys received annually: larger-volume HHAs that receive 40 or more completed HHCAHPS surveys in a performance year, and smaller-volume HHAs that receive fewer than 40 completed surveys.
The HHVBP Model will use data already reported by HHAs, including measures in three categories: OASIS, Claims, and HHCAHPS survey data. Each of the five HHCAHPS survey measures account for 6% of the Overall HHVBP Total Performance Score for a combined 30%. This includes the Willingness to Recommend item, which was excluded from HCAHPS VBP. OASIS and Claims data each make up 35% of the TPS score, with Acute Care Hospitalization During the First 60 Days of Home Health Use (ACH), as part of the Claims measure, making up more than one-quarter of the entire TPS score.
For each measure, CMS will calculate an achievement threshold and a benchmark for each cohort to award achievement points and improvement points to evaluate each HHA’s performance against their own earlier performance during the baseline period and the performance of the other HHAs within their cohort.
Contact our CAHPS® team today if you have any questions or would like to learn more!