Prepare Now For the Home Health Value Based Purchasing Model

Article Highlights

  • CMS introduced the Home Health Value Based Purchasing Model (HHVBP) in nine U.S. states in 2016.
  • CMS is planning to roll out the HHVBP program across the entire country in 2022.
  • Home health agencies (HHAs) not currently under the HHVBP program should prepare now to maximize revenue collections.

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The Centers for Medicare & Medicaid Services (CMS) has proposed rolling out their recently-introduced Home Health Value Based Purchasing Model (HHVBP) across the nation starting January 1, 2022.

This model was initially introduced in nine U.S. states starting in January 2016. After completing a multi-year review period, CMS determined that the HHVPB model met the “statutory requirements” for nationwide expansion.

This means that all U.S. home health agencies need to be aware of how the HHVPB model works, how to meet certain quality measures, and how the model could impact your revenue collections in the short term and in the long term.

What Is the Home Health Value Based Purchasing Model?

The HHVBP model was introduced by CMS to improve the patient experience by providing incentives for home health agencies to offer better care to homebound Medicare beneficiaries.

CMS initiated this model to determine whether offering payment incentives to home health agencies (HHAs) would improve the quality and delivery of home health care services to individuals with Medicare.

When the program started in 2016, all Medicare-certified home health agencies in the states of Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington were tasked with competing on value according to the HHVBP model, where payment is tied to quality performance.

When the model is implemented across the country, CMS hopes to eliminate selection bias and create meaningful improvements to the quality of care provided by all Medicare-certified HHAs on a national basis.

For HHAs that currently participate in the HHVBP program, your agency should continue to optimize quality performance. Because the program is being expanded, you can expect to continue to be required to meet certain requirements over time. Laying a solid foundation now will help you in the future. For HHAs not in one of the nine model U.S. states, now is the time to start thinking ahead to the future.

Information For HHAs Not Currently Participating in HHVBP

Home health agencies that currently do not participate in the HHVBP program need to be prepared for the nationwide rollout so that you can position your agency for success in the program. Specifically, you want to be able to receive the maximum upward payment adjustment that you are entitled to.

The maximum payment adjustment (MPA) is a key piece of the program. Home health agencies in the nine U.S. states that participated in the initial program were subject to the following adjustment schedule:

  • MPA of 3% (upward or downward) in 2018.
  • MPA of 5% (upward or downward) in 2019. 
  • MPA of 6% (upward or downward) in 2020.
  • MPA of 7% (upward or downward) in 2021.
  • MPA of 8% (upward or downward) in 2022.

As you can see, the higher quality of care that your HHA provides over time, the greater payment benefit you can expect to realize. The same schedule is expected to be applied to HHAs in the remaining U.S. states that will be part of the expanded program.

However, HHAs that are unable to demonstrate a high quality of care to patients could experience a short-term revenue hit (downward payment adjustment), followed by long-term concerns about revenue collections if they are unable to meet the requirements over time.

How Are Payments Determined in the HHVBP Program?

CMS uses a few different measures and benchmarks to assess the performance of a home health agency. Your agency’s metrics are updated on a quarterly basis via an Interim Performance Report (IPR) using rolling 12-month data collections. The metrics are also reported on an annual basis via a Total Performance Score (TPS) and in a Payment Adjustment Report.

The percentile rankings reported on the quarterly IPR report and the annual TPS and Payment Adjustment Reports enable HHAs to see how their performance compares to other HHAs within their same U.S. state and other similar-sized HHAs.

To get started, CMS will establish a baseline year for HHAs that are new to the model. Your baseline year is determined by the first calendar year that your agency meets the minimum requirements to generate a score on specific measures:

  • You must have a minimum of 20 home health quality episodes of care that can be measured.
  • You must have 60 or more unique eligible patients in the baseline year.
  • You must have a minimum of 40 completed HHCAHPS (Home Health Consumer Assessment of Healthcare Providers and Systems) surveys.

Once your baseline score is determined, you will then be evaluated in each subsequent performance year. You will be assigned improvement points that are based on a comparison of your agency’s measured value in the performance year against to the baseline year and the benchmark value of your expected performance.

Payments that you receive for services provided are then adjusted upward or downward based on your percentile ranking.

Work With PMB To Support Your Involvement in HHVBP

Precision Medical Billing (PMB) can help home health agencies prepare to participate in the HHVBP program. We’ll review your current processes and also discuss an outsourced billing solution to optimize claim submissions and revenue collections.

We will assign you a dedicated revenue recovery associate for Medicare, and another for insurance billing. As your go-to contact, our experts work with you to maximize your earning potential by meeting the requirements of the CMS program.

Our goal is to help you collect every dollar that you are entitled to by driving toward upward payment adjustments each year that your agency participates in the program.

Contact us today to discuss preparing your agency for the Home Health Value Based Purchasing Model program so that you can focus on providing a higher quality of care to patients. We’re here to help you be successful while alleviating administrative burden.