Value-based purchasing for home health may be closer than you think
In January 2016, the Centers for Medicare & Medicaid (CMS) implemented the Home Health Value-Based Purchasing (HHVBP) Model in an effort to improve the quality and delivery of home health care services to Medicare beneficiaries.
Using the lessons learned from other value-based purchasing programs, CMS is hoping that aligning payment with quality will incentivize home health agencies to increase their focus on patient care, outcomes and the overall patient experience.
While value-based purchasing for home health is still being piloted in nine states, it is important for all agencies to prepare now. Agencies may find this beneficial with current referral sources that are looking to positively impact their own patient care and business objectives.
Here are some areas of your business to explore in order to succeed with value-based purchasing:
Staff: Create a culture of engaged staff. Involve and train everyone on the measures that affect payment adjustments and reimbursements.
ASK YOURSELF: Have you implemented processes and tools to help ensure that your clinical documentation and back-office quality measures are meeting the required standards?
Data: When reviewing and analyzing your agency’s data in the Home Health Compare database, continually identify the measures, trends and areas of improvement that could impact your Total Performance Score. Also, you should monitor clinician documentation and track the frequency of OASIS-C1 corrections, because accurate and complete data is of the utmost importance.
ASK YOURSELF: Are you able to run reports and analyze data readily within your organization?
Payers: Review all of your payers, as performance and documentation issues may become evident with private payers before you see it in Medicare. This will allow you to correct the concerns before your payments are affected.
ASK YOURSELF: Are you seeing an increase in denials? Are your processes and tools supporting accurate and timely billing?
Survey Results: Focus on your HHCAHPS results to track your survey response rates. Low response rates could negatively impact your Total Performance Score.
ASK YOURSELF: Are you striving for 5-Star ratings? Which 5-Star measurements need the most focus?
With this new initiative to focus on data-driven performance, home health organizations must begin to evaluate the status quo and prepare for success. As we have learned from prior experience, pilot programs tend to roll out nationwide at some point, so it is in your best interest to be proactive and start preparing today!