New PIPR report addresses VBP payment questions

As soon as the Centers for Medicare and Medicaid Services (CMS) announced plans to expand the Value-Based Purchasing Model (VBP) to home health agencies nationwide, SimiTree financial consultants began hearing one question again and again:

How will VBP affect my agency’s reimbursement? Will we see an increase or a decrease?

SimiTree’s answer: That depends on your performance metrics on each of the VBP measures.

Under VBP, CMS compares an agency’s 2023 performance metrics in certain key areas to national averages and benchmarks from the baseline year, 2022, to create an overall VBP performance score. The score will impact Medicare payments in 2025.

“The total payment adjustment will be between a 5 percent increase or a 5 percent decrease – so the impact can be significant,” said SimiTree Financial Consulting Director Mike Simione.

How VBP performance will impact payment

Until now, there has been no real way to forecast exactly how an agency might fare in the first performance year under VBP, which officially began Jan. 1, 2023, when compared to national averages, benchmarks, or 2022 metrics.

SimiTree consultants could show agencies which performance metrics would matter under VBP – from certain OASIS items and claims-based quality measures to patient satisfaction ratings captured on the CAHPS Survey.

“Without the data needed for comparison, there has been no way to definitively preview the projected impact of performance on payment under VBP, and answer the question on every agency’s mind about whether they can expect to see an increase or decrease,” Simione said.

Now, for the first time, an important new report from the Centers for Medicare and Medicaid Services (CMS) is shedding some light on how home health agencies are performing in key areas that will be used to calculate performance scores under VBP – and, ultimately, payment adjustments in 2025.

What is the PIPR report?

In November, CMS released an important new report detailing performance metrics from 2022, the year CMS will use as the baseline year for VBP. Data made available in this report is for Q1 and Q2 YTD (based on the measure.)

The Pre-Implementation Performance Report, known by the acronym PIPR, details quality measure performance data that will be used under VBP. It shows home health agencies where they may fall in regard to the first two quarters of the baseline year 2022, and how they compare to other home health agencies nationwide, within peer volume.

“This PIPR is a helpful new report that is a prelude to the first Interim Performance Reports (IPRs) which are expected to be released by CMS in July 2023,” said SimiTree Senior Clinical Consulting Manager Charlie Breznicky, RN, MSN, MBA.

The PIPR report is available to download from the Internet Quality Improvement and Evaluation System (iQIES).

PIPR report webinar planned for Feb. 2

Breznicky will present a 30-minute complimentary webinar at Noon EST on Thursday, Feb. 2, to explain the new PIPR report: where to find it, how to use it, and why it is so important to take corrective action in areas it shows an agency may not be performing well.

SimiTree can help

SimiTree consultants can help agencies take the necessary steps to ensure stronger performance scores under VBP, improve overall financial performance, and increase profitability despite tighter margins. Our clinical operations specialists have the expertise to develop action plans specifically targeting problem areas under VBP, and our financial experts can help agencies streamline their revenue cycle for optimized performance.

Use the form below to contact us today to ask your question about VBP consulting or financial performance.