Athletes participating in triathlons must be strong runners, swimmers and cyclists to be successful in their races. They can’t rely on just one skill to carry them through. Likewise, home health organizations participating in value-based purchasing cannot rely on one aspect of their business for success. They must manage patient outcomes from the Outcome and Assessment Information Set (OASIS), prevent rehospitalizations and ensure positive scores in their Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys.
2023 is the first year of data collection for home health value-based purchasing (HHVBP), and outcomes will impact reimbursement with up to a 5% increase or decline in payments in 2025. It’s critical for home health organizations to understand the HHVBP measures and adjust their quality improvement plans accordingly to remain financially stable in the upcoming years.
HHVBP Measure Weights
Reimbursement under HHVBP will be weighted on the following elements:
OASIS-based measures: 35%
- Improvement in dyspnea
- Discharged to community
- Improvement in management of oral medications
- Total normalized composite change in self-care
- Total normalized composite change in mobility
Claims-based measures: 35%
- Acute care hospitalization during the first 60 days of home health
- Emergency department use without hospitalization during the first 60 days of home health
HHCAHPS measures: 30%
- Care of the patient
- Communication between the providers and patient
- Specific care issues
- Overall rating of home healthcare
- Willingness to recommend the organization
Calculating the Score
Each measure will receive a score between zero and 10, depending on the home health organization’s performance. The maximum score of 10 points is awarded when the performance falls in the top 10% of all organizations (benchmark score).
Points are also awarded based on two other criteria: how much better the organization performed on each measure as compared to the mean of all organizations (achievement score) and how much better the organization performed in the current year as compared to their own performance in the baseline year (improvement score). If an organization earns both achievement score points as well as improvement score points, then the higher value will be awarded.
If an organization’s performance does not improve and if they are below the mean score, they will not receive any points.
To relate this back to the triathlon comparison, the benchmark would be those elite performers who receive medals for being in the top 10%. Achievement score points can be thought of as those who outperform the majority of the competitors, and those who achieve a new personal record can receive improvement score points.
Winning Strategies for VBP
Providing high-quality home-based care and keeping patients out of the hospital is critical for getting high scores in HHVBP. However, quality improvement must take place across the organization. These strategies can help home health organizations focus their efforts for success in HHVBP:
- Ensure OASIS accuracy. Ensure all staff members are well-educated on OASIS-E and understand how to complete the items accurately. Consider timely education on OASIS through resources like the Axxess Training and Certification Program. Software partners with an OASIS scrubber, like Axxess Home Health, can check for inconsistencies and errors before submission.
- Engage and retain staff. Opportunities for staff to grow and develop in their careers can improve retention. Education and engagement are key.
- Analyze the data. Use reporting tools and real-time dashboards to stay on top of outcomes and inform quality improvement plans.
- Grow patient engagement. All home health organizations must be aware of the questions in the HHCAHPS and monitor patient results against market benchmarks.
2023 performance will be calculated in 2024 and paid in 2025. Patient outcomes occurring now will have a significant impact on organizations in the years to come, so home health organizations must act now to ensure their success.
As with any triathlon, having a good coach is key. Join us in April for the Axxess Growth, Innovation and Leadership Experience, or AGILE, for in-depth training on winning strategies for VBP.