By Charles Breznicky Jr., RN MSN MBA HCS-D, Clinical Consulting Director
In the CY 2022 HH Final Rule, CMS indicated its plan to expand the Home Health Value-Based Purchasing (HHVBP) Model to all 50 states, the District of Columbia and U.S. territories beginning January 1, 2023. Under this model agencies will compete, on a national level, against other agencies on selected quality measures. In this final rule CMS indicated the baseline year would be 2019, allowing agencies to identify areas in which to improve in preparation for HHVBP going live in 2023.
In the proposed rule released in June 2022 CMS has proposed several changes to the upcoming HHVBP model.
- CMS is replacing the term “baseline year” with the terms “HHA baseline year” and “Model baseline year.” These terms are defined below:
- HHA baseline year – the calendar year used to determine the improvement threshold for each measure for each individual agency.
- Model baseline year – the calendar year used to determine the benchmark and achievement threshold for each measure for all competing agencies.
- Additionally, CMS has proposed to change the HHA baseline year and Model baseline year from CY 2019 to CY 2022 and anticipates providing agencies with their individual improvement thresholds in the summer of CY 2023, which is consistent with the original HHVBP Model where agencies received their improvement thresholds during the first performance year.
What does this change mean?
The change in the baseline years means that agencies will no longer be able to look back to see which areas they need to improve upon for success under HHVBP … or does it?
Agencies can still take action to increase their chances of success in HHVBP in 2023; see below for some tactics that may be helpful. Keep in mind, the work of improving outcomes, hospitalizations and patient experience is not meant to occur once; instead, it is an ongoing process that will require agencies to thoroughly and regularly evaluate how they provide care, how they measure the quality of that care and how they can improve the care they provide. All of which are key elements of a successful QAPI program.
- Trend your data over the past 6–12 months looking for any measures that significantly declined or improved.
- If you implemented any changes during this time, evaluate their effectiveness. For those that led to the desired result of improved outcomes, identify potential causes of success and work to replicate those interventions.
- For any items that declined, determine potential causes to evaluate if the negative trends are likely to continue and what can be done to reverse the downward slide.
- Compare your current outcome scores to national scores wherever possible; this allows you to identify measures on which you are performing better than and worse than the national average.
- Continue to monitor those measures in which you are better than the national average and develop plans for improvement if you notice a downward trend or dip below the national average.
- To determine why a specific measure may be below the national average, consider the following:
- Staff may not understand how to score the OASIS item in question, limiting how much improvement can be seen at discharge.
- Hospitalization risk may not be accurately identified at SOC, so interventions to reduce the risk of hospitalization may not be implemented.
- Your survey response rate is low, which may mean patients with a negative experience are responding as opposed to those with positive experiences.
- Is your case mix index in line with the perception of the acuity of your patients; in other words, are your staff saying their patients are sicker than other agencies, but the case mix index is lower than state and national averages? If so, Coding and OASIS scoring should be evaluated as this can impact your risk-adjustment scores.
- Narrow your focus by selecting one or two measures to work on at a time, develop a plan for improvement and track progress. You may find that working on one measure has an unexpected effect on another; for example, working to improve scores on the HCHAPS related to medications may lead to improved scores in the Management of Oral Medications OASIS item and could decrease Acute Care Hospitalizations if patients were going to the hospital with medication related issues.
- Regardless of the baseline year, agencies should constantly be looking at their customer service practices which tie directly to the HCAHPS survey; educate all staff on customer service basics then provide deeper education to review specific scenarios staff may face in their role.
SimiTree can assist
The SimiTree team has expertise in Leadership and Management, Organizational Change, QAPI, and Data Analytics. These skillsets can assist agencies in identifying outcomes to be improved, developing processes to be updated and implementing the changes that will lead to better outcomes and patient care delivery. Some examples of how we can help you prepare for HHVBP are:
- Develop a personalized plan to improve your outcomes.
- Track and summarize your data regularly, along with providing recommendation for improvement.
- Create education plans and provide education to staff and managers on outcomes that will be impacted by HHVBP.
- Oversee or assist in the management of specific action plans or your QAPI program.
By Charles Breznicky Jr., RN MSN MBA HCS-D
Clinical Consulting Director