Expanded Home Health Value-Based Purchasing Model

Pre-Implementation Performance Reports (PIPR) Available in iQIES. Instructions on how to access your HHA’s PIPR as well as an on-demand recording and written resource describing the PIPR are available below, under Model Reports. 

Building upon experience from the original Home Health Value-Based Purchasing Model (HHVBP Model), this page provides information, resources, and technical assistance to support implementation of the expanded HHVBP Model nationwide.

Have questions about the expanded HHVBP Model? Please send questions to HHVBPquestions@lewin.com. Be sure to include your name and the home health agency’s name and CCN.

Highlights
  • In a fee-for-service health system, Medicare beneficiaries who qualify for home health care often receive inadequate, uncoordinated care for their chronic health conditions, resulting in more visits to the emergency room, more admissions to the hospital, or more placements in a skilled nursing facility.
  • The Expanded Home Health Value-Based Purchasing (HHVBP) Model seeks to improve the quality and efficiency of home health care across the nation to improve patients’ experience with their care, strengthen their physical function and address health issues before they require an emergency room visit.
  • The Expanded HHVBP Model builds on the success of the original HHVBP Model, which decreased unnecessary emergency room visits, improved patient mobility, and reduced Medicare spending.

Background

As authorized by section 1115A of the Act and finalized in the Calendar Year (CY) 2016 Home Health Prospective Payment System (HH PPS) final rule (80 FR 68624), the Center for Medicare and Medicaid Innovation (Innovation Center) implemented the Home Health Value-Based Purchasing (HHVBP) Model (“original Model”) in nine (9) states on January 1, 2016. The specific goals of the original HHVBP Model were to:

  1. Provide incentives for better quality care with greater efficiency;
  2. Study new potential quality and efficiency measures for appropriateness in the home health setting; and
  3. Enhance the current public reporting process.

The original HHVBP Model resulted in an average 4.6 percent improvement in HHAs' total performance scores (TPS) and an average annual savings of $141 million to Medicare without evidence of adverse risks. The evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending. The U.S. Secretary of Health and Human Services and the CMS Chief Actuary determined that expansion of the original HHVBP Model would further reduce Medicare spending and improve the quality of care. On January 8, 2021, CMS announced the certification of the HHVBP Model for expansion nationwide, as well as the intent to expand the Model through notice and comment rulemaking.

The Expanded HHVBP Model

The expanded HHVBP Model began on January 1, 2022 and includes Medicare-certified HHAs in all fifty (50) states, District of Columbia, and the U.S. territories. Calendar Year (CY) 2022 was the pre-implementation year. During CY 2022, CMS provided HHAs with resources and training, to allow HHAs time to prepare and learn about the expectations and requirements of the expanded HHVBP Model without risk to payments. The first full performance year for the expanded HHVBP Model is CY 2023, which began on January 1, 2023. Calendar Year 2025 is the first payment year, with payment adjustment amounts determined by CY 2023 performance. In a payment year, an applicable percent ranging from -5% to 5% applies toward Medicare fee-for-service payments.

hhvbp timeline graphic test

Model Summary

Under the expanded HHVBP Model, HHAs receive adjustments to their Medicare fee-for-service payments based on their performance against a set of quality measures, relative to their peers’ performance. Performance on these quality measures in a specified year (performance year) impacts payment adjustments in a later year (payment year). Cohorts are determined based on each HHA’s unique beneficiary count in the prior calendar year. HHAs are assigned to either a nationwide larger-volume cohort or nationwide smaller-volume cohort to group HHAs that are of similar size and are more likely to receive scores on the same set of measures for purposes of setting benchmarks and achievement thresholds and determining payment adjustments. For more details about the expanded Model, please see the HHVBP Resources section.

Quality Measures

The expanded HHVBP Model measure set currently uses data already reported by HHAs through the Home Health Quality Reporting Program (HH QRP) requirements, or Medicare claims, and HHCAHPS surveys. To reduce reporting burden, HHAs do not need to submit any additional data, at this time, for the expanded HHVBP Model. All expanded Model reports containing expanded Model performance data will be available through iQIES. The expanded Model measure categories and quality measures are shown below.

Measure Category

OASIS-based

Read more

*508 purposes: Type the text that will display when expanded below.*
  • Improvement in Dyspnea/Dyspnea
  • Discharged to Community
  • Improvement in Management of Oral Medications/Oral Medications
  • Total Normalized Composite Change in Self-Care/TNC Self-Care
  • Total Normalized Composite Change in Mobility/TNC Mobility

Claims-based

Read more

*508 purposes: Type the text that will display when expanded below.*
  • Acute Care Hospitalization During the First 60 Days of Home Health Use/ACH
  • Emergency Department Use without Hospitalization During the First 60 Days of Home Health/ED Use

HHCAHPS Survey-based

Read more

*508 purposes: Type the text that will display when expanded below.*
  • Care of Patients/Professional Care
  • Communications between Providers and Patients/Communication
  • Specific Care Issues/Team Discussion
  • Overall rating of home health care/Overall Rating
  • Willingness to recommend the agency/Willing to Recommend

 

HHVBP Resources

Expanded HHVBP Model YouTube Playlist

Model Overview

FAQs & Model Guide

Model Reports

Newsletters

Quality Measures

Quality Improvement

Total Performance Score & Payment Adjustment

Health Equity

Regulations & Notices

Additional Information

Outreach

If you are interested in receiving additional information, updates or have questions about the Expanded Home Health Value-Based Purchasing Model, please engage with the below resources:

 

 

Last updated on:
01/26/2023