Transition to Value-Based Care
The healthcare industry, particularly home health, is a landscape that is constantly changing with frequent updates on regulatory requirements and new standards. In an effort to improve payment systems, the Centers for Medicare and Medicaid Services (CMS) has recently been promoting value-based care in home health in which the Home Health Quality Reporting Program (HH QRP) plays an important role. In fact, the recent 2022 Home Health Proposed Payment Rule includes CMS’ nationwide expansion plan of the Home Health Value-Based Purchasing and adjustments in the quality reporting measures.asures.
Let us revisit HH QRP and why it is important.
Getting Familiar with the Home Health Quality Reporting Programs
As the world enters a new normal, the focus of CMS remains on advancing value-based care with an emphasis on home health star ratings via the HH QRP. These star ratings are important because they summarize key performance measures in a format that is easily understood, improving the ability of consumers and referral partners to compare and choose high-quality home healthcare providers.
There are two (2) types of star ratings:
- Quality of Patient Care – based on OASIS assessments and Medicare claims data
- Patient Survey Star Ratings – Based on Home Health Consumer Assessment of Healthcare Providers and Systems (HH CAHPS) survey composite data including:
- Care of patients
- Communication between organizations and patients
- Specific care issues
- Overall rating of care provided by the organization
- Likelihood to recommend the organization
Part of the HH QRP is CMS’ Quality Strategy, which focuses on the following:
- Using incentives to improve care
- Tying payments to value through new payment models
- Changing how care is given through:
- Better teamwork
- Better coordination across healthcare settings
- More attention to population health
- Putting the power of healthcare information to work
In a nutshell, the CMS Quality Strategy vision for improving health delivery can be said in three words: better, smarter, healthier.
How Can QRP Affect Your Agency from a Business Standpoint?
Since star ratings can heavily influence which providers consumers and referral partners choose to partner with, it is vital for agencies to maintain good star ratings. In order to increase both types of home health star ratings, HH CAHPS results and the accuracy of OASIS documentation must be improved, as scores are determined by timely submissions and complete data. On the other hand, noncompliance can be costly to providers, as it results in a 2% payment penalty in the corresponding annual payment update year.
One of the ways to boost star ratings is by improving the OASIS accuracy and turnaround time. Your QA/coding provider should be able to support this in a proactive versus reactive manner. This means that your provider should help you identify and address problem areas, such as delays in turnaround time and missing documents, through data reporting. Beyond chart reviews, it is important that your provider’s QA program should also support reeducation of clinicians to improve their patient assessment and charting skills.
Another way to better star ratings is strengthening HH CAHPS Survey Results. Here are quick tips to do so:
- Educate clinicians with the HH CAHPS survey questions and the answer options. Once topics are identified, focus on improving these areas.
- Educate all patients on the survey and encourage them to complete it if contacted by the survey vendor.
- The guidance from CMS allows staff to highlight that a survey will be administered during the Start of Care and Resumption of Care, and patients may be surveyed by the current survey vendor.
- However, a copy of the HH CAHPS survey cannot be shared with patients, nor should the patient be influenced in their answers.
The Future Outlook of QRP
Like with other aspects in home health, it is important to stay on top of QRP, considering the potential changes and updates it might have in the next few months. Here are some factors that may evolve quickly over the next year or two (2) that agencies must closely monitor:
- Ongoing development and implementation of standardized patient assessment data elements (SPADES) in post-acute care
- Revisions and updates on the upcoming OASIS-E implementation
- Updates in the 2022 Home Health Prospective Payment System Final Rule
- COVID-19 vaccination collection and reporting measures
- Continued movement by CMS toward more claims-based measures
All of these will have a significant impact on agencies’ workflows and processes, and therefore should be paid more attention to.
Hitting Two Birds with One Stone
QRP gives a comprehensive view of home healthcare covering both quality of patient care and documentation. With CMS recently making big steps to transition to value-based care, home health providers can look at the QRP as an opportunity to elevate actual patient care and documentation to simultaneously drive better patient outcomes and business sustainability.