How to prepare for VBP

CMS has given home health agencies an extra year to prepare for VBP. Here’s what your organization should do with the extra time.

Home health agencies bracing for a nationwide rollout of value-based purchasing gained a reprieve last month, when the Centers for Medicare and Medicaid Services (CMS) announced the first performance year will be 2023 instead of 2022.

CMS said in the Final Rule for Home Health issued Nov. 2 that it will use quality performance data collected in 2023 to determine Medicare payment adjustments for 2025. Previously, CMS had proposed 2024 payment adjustments, with performance scores counting next year.

“The new timeline means agencies will have an additional year to work on improving their performance scores,” said SimiTree Financial Consulting Director Michael Simione. “2022 will serve as a pre-implementation year where agencies will be required to submit their quality data, but the 2022 quality data will not impact payment adjustments.”

Want to know more about what’s in the CY2022 Final Rule for Home Health? Read 8 Things to Know About the Final Rule, a summary on the SimiTree Healthcare Consulting blog.

How VBP works

Agencies could see positive or negative adjustments of up to 5 percent in their Medicare payments under the Home Health Value-Based Purchasing Program (HHVBP), which has been operating on a pilot basis in nine states since 2016. According to CMS, those states saw a 4.6 percent improvement in Total Performance Scores (TPS) as well as average annual savings of $141 to Medicare.

Total Performance Scores are determined in large part by a mix of claims-based and OASIS-based measures as well as elements of the HHCAHPS Survey. Claims-based measures focus on acute care hospitalization and emergency department use, while OASIS measures report patient self-care and mobility. HHCAHPS Survey items which count include care coordination elements such as team discussion and communication.

What agencies need to do now

SimiTree consultants say a thorough preparation plan for VBP will involve agency self-scrutiny and assessment followed by the implementation of new clinician and patient focused strategies, including data analytics.

“The goal will be overall improvement of outcomes and quality of care,” said Kim Skehan, SimiTree’s Director of Compliance, Regulatory and Quality.

VBP preparation highlights should include: 

  • Review and assessment of current outcome 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

Use data effectively for VBP performance.

A thorough assessment is an essential first step to a successful transition from volume-based to value-based care delivery. SimiTree’s VBP consultants can help by providing baseline scores, state benchmarks and achievement thresholds for each outcome so that we can help your agency align clinical and operational processes with improved outcomes. We’ll trend the data over the past 12 months to determine any fluctuation in your agency’s performance.

SimiTree will help your agency develop a personalized VBP work plan.

SimiTree’s experts will design a personalized plan with process and improvement strategies for improving quality of care in key areas such as bed and toilet transfers, bathing, re-hospitalizations, and other important OASIS measures impacting total performance scores.

QAPI offers a path for VBP improvements.

Your agency’s Quality Assessment and Performance Improvement (QAPI) Program is a natural fit for implementing targeted performance improvement projects to boost weak performance areas. SimiTree Healthcare Clinical Consulting Director Charles Breznicky recommends agencies select one or two quality measures per month in 2022 and develop a plan around improving those measures.

SimiTree can help by working with agencies to develop individualized performance improvement projects (PIPS) based on VBP performance metrics or provide consulting services to QAPI managers to demonstrate how to effectively use QAPI to prepare for VBP. We also offer ongoing QAPI program oversight as an outsourced service.

Staff training will be essential.

With a variety of educational offerings, SimiTree can make certain your team is value ready. We offer specialized on-site VBP workshops, including OASIS training in the measures which will be important under VBP. Our OASIS training is also available virtually. Ready to get started? Reach out to us today at 1-844-215-8823 or use the contact form below to start the discussion about how we can help your agency prepare for VBP!

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