healthcare professional uses mobile tablet

Changes are coming to HHVBP in 2025 — are you ready?

Background of the Expanded Home Health Value Based Purchasing (HHVBP) Model

The expanded HHVBP Model began on January 1, 2022, with calendar year (CY) 2022 being the pre-implementation year, and includes Medicare-certified home health agencies (HHAs) in all fifty states, District of Columbia, and the U.S. territories. The first full performance year (PY) for the expanded HHVBP Model began January 1, 2023, with CY 2025 being the first payment year, which will include payment adjustment amounts upward or downward of 5% that will be determined on CY 2023 performance.

In the expanded model, “cohorts” are determined based on each HHA’s unique HHCAHPS survey-eligible beneficiary count in the calendar year prior to the performance year. HHAs are assigned to either a nationwide larger-volume cohort or nationwide smaller-volume cohort. This approach groups HHAs that are of similar size and are more likely to receive scores on the same set of measures for purposes of setting benchmarks and achievement thresholds and determining payment adjustments.

In the CY 2022 Home Health PPS Final Rule, the Centers for Medicare and Medicaid Services (CMS) finalized the Expanded HHVBP Model measure set effective for the CY 2022 pre-implementation year and subsequent years, which currently includes five OASIS-based measures, two claims-based measures, and five HHCAHPS Survey-based measures. Data from OASIS, HHCAHPS, and claims-based measures are used to calculate the HHAs’ Total Performance Score in a performance year, which is a numeric score awarded to each HHA based on the weighted sum of the performance scores for each applicable measure.

The table below serves as a reference for the current measure set for the Expanded HHVBP Model, which is effective for CYs 2023 and 2024.

Measure Category Measure Full Title/Short Form Name (if applicable)
OASIS-based Improvement in Dyspnea/Dyspnea
OASIS-based Discharged to Community
OASIS-based Improvement in Management of Oral Medications/Oral Medication
OASIS-based Total Normalized Composite Change in Mobility/TNC Mobility
OASIS-based Total Normalized Composite Change in Self-Care/TNC Self-Care
Claims-based Acute Care Hospitalization During First 60 Days of Home Health Use/ACH
Claims-based Emergency Dept. Use without Hospitalization During First 60 Days of Home Health/ED Use
HHCAHPS Survey-based Care of Patients/Professional Care
HHCAHPS Survey-based Communications Between Providers and Patients/Communication
HHCAHPS Survey-based Specific Care Issues/Team Discussion
HHCAHPS Survey-based Overall Rating of Home Health Care/Overall Rating
HHCAHPS Survey-based Willingness to Recommend the Agency/Willing to Recommend
*Source: Table D1: Current Measure Set for the Expanded HHVBP Model; CY 2024 Home Health Prospective Payment System Final Rule

In the CY 2023 Home Health PPS Final Rule, CMS changed the Model baseline year to CY 2022, to use more recent data from the CY 2022 time period, because it was more likely to be aligned with the performance years’ data under the expanded Model, and expected to provide a more appropriate baseline for assessing HHA improvement for all measures under the Model as compared to data collected prior to and during the COVID-19 public health emergency.

With the passing of the CY 2024 Home Health PPS Final Rule in November of 2023, CMS has now finalized several changes to the Expanded HHVBP Model (which will be effective in CY 2025) inclusive of the removal of five measures, and addition of three measures to the current measure set. It also includes adjustment to the weights for the measures in the OASIS and claims-based categories, and changing the Model baseline year to 2023 for all measures beginning with Performance Year 2025. With all of these changes coming soon, it will be very important for HHAs to be aware of what is changing and when, to ensure adequate preparation ahead of the planned effective date.

Let’s take a closer look at the upcoming changes:

Expanded HHVBP Model measure changes

In the CY 2024 HH PPS Final Rule, CMS determined that five of the measures previously finalized in the CY 2022 HH PPS Final Rule required further consideration and subsequently finalized their proposal to remove five measures from the current HHVBP Measure Set (three OASIS-based measures and two claims-based measures) and replace them with three measures (one OASIS-based measure and two claims-based measures) effective for the CY 2025 performance year. There were no changes to the current five HHCAHPS Survey-based measures. These finalized measure changes for Performance Year 2025 are depicted in the table below.

Removed Replaced By
1. Discharge to Community (DTC) [OASIS-based] 1. Discharge to Community-Post Acute Care (DTC-PAC) Measure for Home Health Agencies [Claims-Based]
2. Total Normalized Composite (TNC) Change in Self-Care [OASIS-based]
2. Discharge Function Score Measure (DC Function) [OASIS-based]
3. Total Normalized Composite (TNC) Change in Mobility [OASIS-based]
4. Acute Care Hospitalization During the First 60 Days of Home Health Use (ACH) [Claims-based]
3. Home Health Within-Stay Potentially Preventable Hospitalization (PPH) Measure [Claims-based]
5. Emergency Department Use Without Hospitalization During the First 60 Days of Home Health (ED Use) [Claims-based]

These changes will align the measures used in the expanded HHVBP Model with the measures in the Home Health Quality Reporting Program (HHQRP) and publicly reported on Home Health Care Compare. CMS’ intention behind this alignment is to support comparisons of provider quality and streamline home health providers’ data capture and reporting processes.

The finalized Expanded HHVBP Model measure set that will be effective for 2025 performance year (CY 2027 payment year) and subsequent years is summarized below:

3 OASIS-based measures:

  • Improvement in Dyspnea/Dyspnea
  • Improvement in Management of Oral Medications/Oral Medications
  • Discharge Function Score/Discharge Function

2 Claims-based measures:

  • Home Health Within-Stay Potentially Preventable Hospitalization/PPH
  • Discharge to Community-Post-Acute Care/DTC-PAC

 5 HHCAHPS Survey-based measures:

  • 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

Changes to the quality measure weights within the measure categories

Due to these changes to the applicable Expanded HHVBP Model measure set and the data sources, CMS is also making changes in the weights and redistribution of weights within the measures categories.

CMS will be revising the weights of the individual measures within the OASIS-based measure category and within the claims-based measure category. Given there were no proposed changes to the HHCAHPS Survey-based measure category, CMS is keeping the current individual measure weights for this category unchanged.

Updates to the HHVBP Model baseline year

Beginning with performance year 2025, CMS is updating the Model baseline year to CY 2023 for all applicable measures in the Expanded HHVBP Model measure set, including those measures included in the current measure set. The one exception is the new claims-based DTC-PAC measure, which uses two years of data, so the Model baseline year for the claims-based DTC-PAC measure will be CY 2022 and CY 2023 for the two-year performance year spanning CY 2024 and CY 2025. For performance years in CY 2023 and CY 2024, the Model baseline year will continue to be CY 2022.

As we all know, data analysis is critical for preparing for the HHVBP Model and your software platform and analytics will play a critical role in your success. Don’t be behind when the CY 2025 performance year begins.

Request a demo today to see for yourself how MatrixCare can prepare your agency to compete on value and succeed under the Expanded HHVBP Model.

See what MatrixCare can do for you

Brandy Shifteh

Brandy Shifteh, RN, BHSA, MBA, joined MatrixCare in April of 2018 as a Clinical Informatics Business Analyst, where she has been very involved in the development and enhancement of clinical analytics that supports scrubbing of OASIS assessment data, casemix/HIPPS scoring, clinical assessment reviews and coding. In April of 2019, she transitioned into a Regulations Compliance role, where she is responsible for monitoring regulations that impact home health, hospice and private duty home care, to help ensure our solutions support all existing and new regulations. She is very plugged into the regulatory community with relationships at both the state and federal level and serves as an active member on the National Government Services (NGS) Vendor Coalition group, where she provides input on MAC provider education and materials. Brandy is a Registered Nurse and comes to us with over 23 years of operations management experience in the home health, hospice and private duty home care sector, inclusive of accreditation/survey preparedness, compliance and clinical/quality improvement programming. She holds two undergraduate degrees; science and nursing and health services administration; and an MBA in computer information systems (CIS).

Two office professionals looking at a laptop

See MatrixCare in action

Start by having a call with one of our experts to see our platform in action.