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The ROI of Patient Outcomes and How to Improve Them

Gone are the days of clinicians answering patient outcome questions “from the bottom up” on admission and “from the top down” for discharge.

The original Home Health Value-Based Purchasing (HHVBP) Model was rolled out in 2016 to nine states across the nation. These states would see their organizations shift from a volume-based model to a quality-based payment one. With that came a financial impact.

Quality, outcomes and patient satisfaction became the drivers of performance rather than the number of visits.

With the HHVBP extending nationwide in 2023, home health organizations should implement process changes now. All clinicians need to understand value-based purchasing, the significance of their impact on star ratings and how these ratings drive an organization’s performance, financial stability and competitive marketability.

Why Start Now?

The first financial impact for all organizations will start in 2025. Based on organization performance, patient satisfaction and patient outcomes in 2023, organizations will potentially see a maximum of a 5% reduction or increase in payment.

If an organization does not recognize the significance of their star ratings, the financial impact in 2025 could be detrimental to their success. To earn higher scores in 2023, processes that impact Home Health Star Ratings need to be re-evaluated now. Some organizations have started making changes, fine tuning the accuracy of their documentation and will be prepared when VBP begins nationwide in 2023.

Star ratings are not metrics the director of nursing (DON) or administrator of a home health organization can manage on their own. Star ratings are driven by clinicians in the organization, as a whole, by understanding the process of quality care and the importance of patient satisfaction.

The Value of Five Stars

The star rating is a summary measure of a home health organization’s performance, based on how well it applies best practices when providing patient care, measuring quality of care, outcomes and patient satisfaction. These quality and outcome measures are captured on the Outcome and Assessment Information Set (OASIS) and Medicare claims.

However, many clinicians, especially those new to home health, lack the experience and understanding of how to correctly answer OASIS questions. This guesswork is bad for the patient, bad for the organization, and will often lead to low ratings and poor earnings.

When all clinicians are properly trained to answer OASIS questions, you will have better patient outcomes. The better the patient outcomes, the better your star ratings will be, making you more competitive in your market.

Where to Start with Improving Star Ratings

The answer lies within your hands: technology. More specifically, an intuitive home healthcare software that includes multiple integrations built into the solution.

Look for a software partner that:

  • Offers step-by-step guidance for OASIS questions, providing clinicians with a definition of item intent, response-specific instructions and data sources, utilized to correctly answer the question.
  • Includes the Centers for Medicare and Medicaid Services’ (CMS) reference guide to assist clinicians in answering OASIS questions correctly.
  • Has embedded tools to monitor and improve reportable (quality) process and outcome measures.
  • Ensures all OASIS answers are automatically checked for errors and irregularities prior to completion and submission.
  • Provides an OASIS Scrubber to identify inconsistencies in documentation, including those questions which directly impact star ratings.
  • Eases operations with an OASIS analysis tool, allowing the quality assurance (QA) nurse, DON or administrator to further compare patient improvement or decline of outcome measures.
  • Values interoperability by offering other services that directly affect star ratings, like being a Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPS) vendor, with built-in training and resources for improving results, as well as smooth care coordination.

Value-based purchasing is inevitable. To succeed under VBP, take a closer look at how your clinicians are handling and documenting OASIS questions and consider a solution that can help.

Axxess Home Health, a cloud-based home health software, offers documentation features at the point of care for more accurate answers, with real-time results for a quick QA approval.


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