10 Myths Surrounding the Home Health Value-Based Purchasing Model

Jan 26, 2017 9:00:00 AM

The Home Health Value-Based Purchasing (HHVBP) model launched as a pilot program in nine states on Jan. 1, 2016. The model, which ties payment to performance, represents a major shift in payment structure for home health agencies.

10 Myths Surrounding the Home Health Value-Based Purchasing ModelUsing 20 measures to evaluate performance, HHVBP encourages Medicare-certified home health agencies to achieve three goals:

  1. Provide higher-quality care and increased care efficiency.

  2. Research quality and efficiency measures that can be used in the home health setting.

  3. Improve and enhance the current reporting process.

The program is not without concerns for many agency owners. Multiple new documentation requirements and complicated HHVBP scores can pack a serious financial punch – potentially making or breaking an agency’s bottom line. And yet, the model also empowers agencies to compete on value rather than volume – which can create a positive impact on both business results and patient outcomes.

As we enter the second year of the program, it’s important to clear up any misconceptions surrounding HHVBP, so that agencies can understand precisely what they need to do so succeed in a value-based health care landscape.

Myth #1. The HHVBP Penalizes Small and New Agencies.

Fact: Small or new home health agencies won’t be penalized under this program, because calculations of an agency’s Total Performance Score (TPS) only include measurements with a minimum of 20 home health episodes of care. Also, an agency won’t be subjected to adjusted payments until it generates scores on five measures or more.

Myth #2. Agencies Are Directly Competing With Each Other for Scores.

Fact: Yes, agencies are competing against each other — but that’s not the only competition. Two distinct measures determine your agency’s score:

  • Comparison of an agency with others in the same state
  • Comparison of an agency’s current score against its previous one

These internal comparisons encourage agencies to maintain or improve their high scores and incentives.

Myth #3. My HHA Isn’t in a Trial State, so I Don’t Need to Worry About Compliance.

Fact: CMS has stated it plans to bring all states into this program by 2022; that means every home health agency’s baseline year for determining reward and reimbursement rates is no later than — and maybe earlier than — 2020. That’s just around the corner, so now is exactly the time to improve care and compliance.

Myth #4. A Single Employee Can’t Affect My Agency’s Rating.

Fact: Even one employee who consistently disregards Outcome and Assessment Information Set (OASIS) regulations can lower an agency’s rating and put the agency at significant financial risk.

Identify the caregivers who need to come into compliance, and provide the extra training and guidance all of your caregivers need to thrive.

Myth #5. All Home Health Agencies Must Participate in the HHVBP Model.

Fact: Only home health agencies with current Medicare certifications and that are being paid by CMS for delivering home health services must participate in the program.

Myth #6. HHVBP Compliance Reporting Is Time Consuming.

Fact: Three new data points have been added specifically for the program, which you must manually submit through the HHVBP Secure Portal:

  • Influenza vaccinations for caregivers
  • Herpes zoster vaccinations for patients
  • Advance care planning services

Agencies are already reporting the balance of the required data to CMS via OASIS, Medicare claims and HHCAHPS. This includes two new claims-based measures and five new HHCAHPS-based measures.

Agencies are not required to report data on these three new measures; however, agencies that do not report this data can only earn up to 90% of the points for the TPS.

Myth #7. Agency Reporting Systems Must Be Interoperable with the HHVBP Portal.

Fact: There is no need to test interoperability between systems. You are only required to manually enter data for three new measures (see myth 6 above); other program data is submitted automatically through OASIS, Medicare claims and HHCAHPS.

Myth #8. Only Agencies That Predominantly Serve Medicare Clients Are Subject to HHVBP.

Fact: Participation in HHVBP is based on your agency’s certification status, not the number of Medicare patients served. If your agency is Medicare-certified and has a CCN, you must participate in the program.

Myth #9. All Agencies That See Patients in HHVBP Model States Must Participate.

Fact: Your agency’s participation in the model depends on your agency’s CCN. If your CCN isn’t associated with a pilot state, you don’t need to participate — even if you are caring for patients in a pilot state.

Myth #10. Value-Based Purchasing Models Negatively Affect Profit Margins.

Fact: Not if your agency is in full compliance. If it is, your agency could see reimbursement increase by 8% by 2022. On the other hand, agencies that aren’t in compliance could see payments reduced by 8% over the same period.

Be Prepared for HHVBP Compliance

As CMS is encouraging providers to improve both patient care and the patient experience, it’s also attempting to align payments with quality. With a value-based compensation system, understanding and managing patient care is more important than ever.

CellTrak helps you do just that. Our Mobile Health Solution can help you facilitate care delivery, communicate more effectively, improve compliance, automate data collection, and increase business and care optimization.

Contact us today to learn more about how the CellTrak Care Delivery Management Solution can ensure you’re ready to comply with HHVBP.


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Topics: Cost Reduction, Compliance