Home health agencies are targeting key performance areas such as acute care hospitalization, emergency department use, care coordination and patient satisfaction in a bid to improve their scores for the Home Health Value-Based Purchasing Model (VBP) launching in 2023.
Under the first performance year of the new VBP model, scores from these and other key areas will determine whether agencies receive a payment increase or decrease in 2025.
Agencies could see positive or negative adjustments of up to 5 percent, depending on how well they perform in three key areas, largely a mix of claims-based measures targeting acute-care usage and specific OASIS-based measures focusing on patient self-care, mobility, and medication management.
A third factor in an agency’s total performance score will be calculated from responses to the HHCAHS Survey, a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS).
Total scoring breakdown
Total agency performance scores under VBP will be determined in the following manner
- 35% of the total score will be determined by OASIS measures, making accurate completion of the assessment crucial.
- 35% percent of the score will be based on claims for emergency department visits without hospitalization, and for hospitalizations that occur within the first 60 days of the home care episode.
- The remaining 30% of the score will be based on patient satisfaction (the HHCAHPS survey). Survey items targeted will include care coordination elements such as team discussion and communication.
Agencies should focus their fourth quarter preparations for VBP in shoring up these areas, according to Charles Breznicky, SimiTree Director of Clinical Operations Consulting.
He offers a few tips for improving performance in each of the three areas which will contribute to total performance scores next year.
Oasis accuracy will be crucial
Reducing OASIS errors will be essential for VBP success, Breznicky said.
Focusing on the patient’s physical and cognitive ability to safely perform tasks is vital to OASIS accuracy, Breznicky said. Clinicians will need to consider the patient’s ability to safely access grooming utensils and clothing and safely transfer to or off the toilet or commode. SimiTree offers both virtual and on-site OASIS training to help agency staff better understand how to accurately score these items.
Greater interdisciplinary coordination will also be important under VBP, Breznicky said. He recommends having in place processes that foster better care coordination and require review of all encounters within the first 5 days to accurately score the OASIS.
Clinicians will also need to step up documentation, making certain to include the rationale for any corrections which may be needed for an OASIS item.
Reducing acute care risk
A second area of focus for fourth quarter VBP preparation should be addressing and controlling acute care risk, Breznicky said, with processes in place to adequately evaluate risks and effectively manage care for chronic and complex medical conditions.
Communicate risk factors to all team members for high-risk patients, including those with diagnosis identified as having an increased risk of hospitalization, Breznicky said. Examples of high-risk diagnoses include CHF, COPD, UTIs and wounds.
Effective use of telehealth or remote patient monitoring is essential for addressing risk, and agencies should focus on developing these elements of care management. SimiTree offers consulting services designed to help agencies make better use of telehealth as part of overall workflow and utilization. Improving patient engagement and self-management can also be important to the process, and should be emphasized during readiness efforts, Breznicky said.
Improving patient satisfaction
Patient satisfaction begins with excellent communication, Breznicky said. Fourth quarter preparation for VBP should include consideration of the quality of communication the agency is providing to patients. Is it clear, empathetic, and designed to encourage patients to become active partners in their health care? Is the agency making full use of digital tools and communication methods, which are increasingly important to patients?
Almost every agency could benefit from soft skills training in how to better communicate with patients, Breznicky said, and the payoff could be better HHCAHPS Survey and VBP scores as well as better patient outcomes.
SimiTree can help
SimiTree consultants say VBP preparation should include:
- Review and assessment of current scores, particularly how they compare to state and national benchmarks
- Evaluation of ways to reduce unnecessary costs and minimize hospitalizations via effective patient management
- Use of agency QAPI programs to boost improvement in weak areas
- Staff training for areas which will be affected by VBP
SimiTree’s experts are working with agencies to design personalized plans with process and improvement strategies for improving quality of care in key areas such as bed and toilet transfers, bathing, hospitalizations, and other important measures impacting total performance scores.
With a variety of educational offerings, SimiTree can make certain your team is ready. We offer specialized on-site VBP training, including OASIS training in the measures which will be important under VBP.
Our OASIS training is also available virtually.
Ready to get started? Use the contact form below to start the discussion about how we can help your agency prepare for VBP!
Are you an Insider?
Our free monthly report offers industry insight and analysis from SimiTree experts. Sign up here to get helpful articles like this one in your inbox each month.