The 2024 Home Health Final Payment Rule, released on November 1, 2023, brings significant changes directly impacting the Value-Based Purchasing (VBP) model in 2025. We have summarized these changes and added some notes about their implications.

While VBP generally stays the same in 2024, maintaining the 2022 baseline, the changes will be brought about by the five outcome measures being replaced by three new ones. This shift will adjust the weight of individual items, affecting the Total Performance Scores (TPS). Importantly, the method for calculating HHCAHPS measures and their 6% contribution to the Total Performance Score remains unchanged.

1. The new Discharge Function Score (DFS) will replace the existing Total Normalized Composite Change in Self-Care and Total Normalized Composite Change in Mobility measures, which depend on the 1800 items on the OASIS.
   
   This new Discharge Function Score measure will be solely based on GG0130 and GG0170 items. Specifically, only Eating, Oral Hygiene, and Toileting Hygiene from GG0130 will be used in calculating this score.
   
   The Discharge Function Score based on GG items, uses patient info from the Start of Care or Resumption of Care OASIS in a new CMS algorithm. This algorithm predicts the expected discharge status based on the documented patient status during SOC or ROC.  If the agency’s reported discharge status matches or exceeds the algorithm’s calculation after submitting the Discharge OASIS, it leads to a positive measure outcome.
   
   
2. A new Discharge to Community-Post Acute Care (DTC-PAC) measure, which will then utilize claims data, will replace the current OASIS-based Discharge to Community (DTC) measure.
   
   This change impacts Value-Based Purchasing calculations, with the new measure using a 2-year data span instead of 12 months.
   
3. A new single Potentially Preventable Hospitalization (PPH) measure will consolidate the existing Acute Care Hospitalization (ACH) and Emergency Department (ED) measures. The PPH, combined with the Discharge to Community-Post Acute Care Measure, will constitute the claims data for the VBP model.
   
   Keep in mind that the PPH measure incorporates Observation stays. Consequently, if a patient under Home Health care undergoes an Acute Care Hospitalization or Observation stay, it will adversely affect the measure outcome.
   
4. Both the Improvement in Dyspnea and Improvement in Management of Oral Medications measures will continue to be included in the model, but there will be a slight adjustment to their weight impact on the overall TPS.

Preparing for the Changes

The changes to the Value-Based Purchasing model pose a challenge and require staff education by 2025, particularly focusing on GG items. This is crucial for sustaining success in the VBP mode considering the newly introduced measures. Nationwide data indicates a lack of sufficient education for GG items in the OASIS compared to ADLs in the M1800 section.

Home health agencies should ensure that their staff receives sufficient education as early as possible. In addition, utilize QA audits to help ensure accurate responses to GG items and support continuous learning for clinicians.

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The latest version of the Performance and Improvement Progress Report (PIPR) was released in April 2023, accessible through the iQIES system, your usual source for CASPER reports.

PIPRs show your current percentile ranking for each outcome measure when compared to agencies nationwide that belong to your cohort in the ongoing calculations for the 2023 Value-Based Purchasing expansion. The last 3 PIPRs are based on your data from the previous year through parts of 2022. 

Starting July 2023, PIPR featuring 2023 data will be released, featuring up-to-date achievement thresholds and benchmarks from the baseline year 2022. These reports will be used to calculate the outcomes for 2023.

To understand your organization’s standing relative to other agencies in specific outcome measures for the current year, it is crucial to review the PIPR reports as the expansion progresses. Suppose your measures rank at the 51st percentile or higher. In that case, you will likely earn the payment incentives once all 2023 data has been gathered and reimbursement impact calculation is done. 

Check CMS Website for HHVBP Related Updates

The Centers for Medicare & Medicaid Services (CMS) has a dedicated section for Value-Based Purchasing on its website. In a recently released April newsletter, CMS covers the updated resources on risk adjustment factors and modifications in the Home Health Quality Reporting program.  

Moreover, one of the updated documents focuses on risk adjustment, specifically discussing the risk adjustment factors that affect the calculation of Total Normalized Composite Change in Mobility and Self-Care Measure (TNC).  

CMS addresses the risk adjustment factor of excluding patients from calculations for Dyspnea, Oral Meds, the TNC measures, and Discharge to Community. Patients are excluded from these measure outcome calculations if they have been discharged to a non-institutional hospice. This positive development underscores the importance of understanding its implications on your outcome measures.

Utilize the following resources if you are interested in receiving additional information, updates or have questions about the Expanded Home Health Value-Based Purchasing Model:

• Listerserv: Subscribe to the HHVBP Model Expansion listserv
• Email questions to: HHVBPquestions@lewin.com

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To gear up for the implementation of the expanded home health value-based purchasing (HHVBP) model in 2023, the Centers for Medicare and Medicaid Services (CMS) has already issued the November 2022 Pre-Implementation Performance Report (PIPR) to all active home health agencies, which is now available to download iQIES Portal.

With the PIPRs, home health agencies are able to see their overall HHVBP quality measure performance in comparison to other agencies nationally within peer cohorts in the new baseline year of CY 2022. It is of utmost importance that agencies access this information as it is vital in anticipation of the release of the first Interim Performance Reports (IPRs) in July 2023. Hence, the HHVBP Technical Assistance team provided resources that provide instructions on how to access the PIPRs here, as well as information on the purpose, content, and use of the PIPRs here.

Harnessing HHVBP to Your Advantage

HHVBP is a double-edged sword, as it is a challenge and an opportunity for agencies simultaneously. However, with the right strategy, HHVBP can drive business growth and promote excellent healthcare services since it provides incentives for home health agencies that deliver quality patient care. The opportunity to explore growth opportunities is ripe for the taking.

Leveraging QA

Considering all the changes that are underway with the industry’s transition to value-based care, home health agencies can use all the help they can get to be at the winning end.

For one, your QA program can help optimize your data on OASIS-based measures used in the HHVP performance scoring. Your QA provider should be able to capture problem areas and support aspects like the re-education of clinicians for ongoing quality improvements in the documentation. These efforts will not only improve and maintain your documentation accuracy, but significantly contribute to earning incentives in the HHVBP game.

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A Gerontological Society of America study stated that “home health patients are at greatest risk of hospitalizations within the first weeks of home health. Over 25% of hospitalization occurred in the first 6 days and over 50% occurred in the first 2 weeks.” Another study based on 1.4 million Medicare cases from the Centers for Medicare and Medicaid (CMS) indicated that physical and occupational therapy yields positive results in post-acute care like reduced readmissions. 

Under Home Health Value-Based Purchasing (HHVBP), the claims-based measures comprised of Acute Care Hospitalization (ACH) and Emergency Department Use (ED Use) account for 35% of the Quality Measure Weighting. This proves that multidisciplinary care could make a difference in re-hospitalization and ED Use when implemented early in the episode of care.

All About the Bigger Picture

In preparation for HHVBP, agencies are gearing up on staff education on scoring the items that make up the OASIS-based Quality Measures in HHVBP. Most often than not, agencies are too focused on the data that they forget there is a real patient behind it who might have underlying needs.

Value management is definitely more than scoring the OASIS assessment. While clinicians responsible for OASIS completion should have a working knowledge of how to score all OASIS items, they should also be knowledgeable about what to do with this information. In developing the plan of care, clinicians should look beyond the skilled nursing needs and consider other potential needs of the patient.

For instance, the Total Normalized Composite Change in Mobility (TNC Mobility) and Total Normalized Composite Change in Self-Care (TNC Self-care) are both crucial OASIS-based Quality Measures in HHVBP and are key indicators for physical or occupational therapy needs of a patient. Moreover, both make up 50% of the total OASIS scoring impact on the Total Performance Score (TPS).

Clinicians play a crucial role in assessing the patient’s physical limitations, as well as their environmental, behavioral, and cognitive challenges. They prescribe necessary therapy interventions to improve the patient’s safety and allow them to stay in the comfort of their home after being discharged from home health. For instance, if a patient shows a high risk for functional limitations in achieving tasks or exhibits cognitive decline of any sort, physical and occupational therapy, and speech and language pathology should be considered respectively as these challenges could potentially lead to a hospital visit. 

Overall, agencies must ensure a patient-focused plan of care that keeps individual patient goals in mind. Ways to decrease rehospitalization rates or ED use must be identified. Agencies should also determine where they stand when it comes to patient satisfaction.

Win-Win for Agencies and Patients

Since therapists work with the patient, their family, and caregivers by providing education and support for patient safety at home, therapy disciplines definitely play a vital role in their ability to safely remain in the OASIS M242O D/C Community and out of the hospital.

Any improvement in any of the OASIS-Based Measures, along with lesser risk for rehospitalization and a comprehensive plan of care, is a win for both the agency and the patient. The latter’s wins are remaining in their home, satisfaction with the care provided, and their inclination to recommend the agency to others. The former’s win is the improvement of scores between discharge and the start of care.

Make sure your clinicians are able to anticipate and identify the needs of patients in order to provide holistic care that is right for each patient’s unique needs. Additionally, your QA team or provider should be able to help your clinicians recognize key areas that describe patient needs based on assessments in the documentation.

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Home health agencies need to start gearing up for the imminent 2023 performance year of the expanded Home Health Value-Based Purchasing (HHVBP) program by understanding the data sources and measures used in the calculation of performance scores and corresponding payment adjustments.

While the OASIS and claims-based components are data-driven, the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) portion is about patient perception and counts for 30% of the overall VBP score. What constitutes patient perception is how patients feel after visits, which is hardly fact or evidence-based. Therefore, it is vital for home health agencies to ensure patient satisfaction.

Here are 5 best practices that will help improve your overall survey HHCAHPS scores:

1. Reach out to your patients.
   In addition to the mandatory follow-ups, agency management should consider going the extra mile to reach out to current clients. Ask for feedback, make sure they are satisfied with the services they are receiving, and address concerns before they are escalated to becoming negative reviews. Regular mini-surveys via telephone, email, or physical forms can also contribute to gathering insights on ways to improve. 

2. Work with a survey contractor that has a high survey response rate.
   Having your survey drive higher-than-average survey responses is vital to decreasing the weight of one or two negative responses. For many smaller agencies, this supposedly low number can significantly sway their overall score.

3. Review patients’ feedback on the surveys.
   When clients take the time to write their comments, they either have a very negative experience or a very positive one. Hence, it is critical to review these and address them appropriately. Moreover, make sure that your survey vendor provides verbatim accounts of patient and family feedback in their reports. 

4. Discuss the report with your staff.
   Hold quarterly company-wide meetings with administrators and clinicians to review the survey reports. Take it as an opportunity to identify areas of improvement and reinforce the importance of taking negative comments and ratings seriously.

5. Gather the necessary comparative data.
   In the expanded Model, agencies are assigned to either a nationwide larger-volume cohort or a nationwide smaller-volume cohort to group agencies 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. To ensure success, home health agencies need to understand their place within their national cohort on top of their own survey ratings. It is all about the actual proximity of scores, hence the need to identify actual performance ranking in relation to other agencies.

Accountability and Constant Improvement

Aside from elevating the accuracy of your OASIS and claims data through clinician education and a strong QA review program, improving the HHCAHPS rating scores is also a crucial factor in earning incentive opportunities from the value-based purchasing program. Not only does the HHCAHPS survey make up 30% of the VBP score, but it also provides meaningful and useful information that will help improve systems and operations. More importantly, it holds providers accountable for their services and reinforces the need to deliver quality patient care.

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The value-based care model was intended to be beneficial not only to patients, but also to healthcare providers. However, a recent survey reflecting the views of home-based care professionals on navigating value-based care showed that 63% of providers are either on the fence or indifferent about its impact. At the same time, the survey results revealed other key insights and an indication of optimism about the effect of value-based care on revenue, patient outcomes, mergers and acquisitions (M&A) activities, and more. The survey aims to identify value-based care trends and their impact on different stakeholders.

Potential for Business Development

Even though 54% of the respondents reported that value-based contracts account for very little of their organizations’ current revenue, this scenario is expected to change in the next three to five years. Nearly 42% are positive that most of their organization’s revenue will come from value-based contracts.

When it comes to M&A, 60%of respondents predict an increase in this business activity due to value-based care. In addition, 63% consider better patient outcomes as the top benefit of value-based care in home health, followed by increased patient satisfaction.

Challenges and Areas of Improvement

Navigating the value-based care model comes with challenges. According to survey results, the greatest challenge is data—its analysis, integrity, and gathering from multiple sources—followed by staff education. Consequently, the top priorities in value-based care are interoperability and tracking client satisfaction. 

As far as adopting new practices in care delivery is concerned, 64% of participants believe that employing schedule and route optimization tools will be a standard to help in caregiver-centric scheduling. This is followed by an increase in virtual care at 56% and harnessing data from tech-wearable integration at 54%.

Overcoming Hurdles Through Tech and Strategic Partnerships

To take advantage of growth opportunities in value-based care, home health providers first need to address challenges that come along with it such as interoperability, data optimization for better patient outcomes tracking, and most importantly, staffing.

The need for clinician schedule and route optimization underscores the bigger need for more efficient staffing utilization. The goal is to maximize clinical staff for patient care and use other solutions to cover other key functions, such as documentation and compliance. Along with utilizing technology, agencies can leverage an outsourced clinical team to provide support for back-office functions.

When efficiencies are realized in all areas of the home health operations, the clinical workforce and other resources can be allocated to optimizing patient care delivery. This creates a domino effect wherein agencies are better equipped to pursue business growth in a value-based care landscape.

The survey was conducted from March 9 to April 4, 2022 by Home Health Care News in partnership with a home care software provider, AlayaCare. Download the full survey results here>

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Several agencies have attested that the Home Health Value-Based Purchasing (HHVBP) initiative has meaningfully improved the quality of care for their patients. There has been a decline in the re-hospitalization of home health patients, which led to an average of 141 million dollars of yearly savings on Medicare spending. Moreover, the average improvement for quality scores with the HHVBP pilot was 4.6%. 

With 2022 being the pre-implementation year, CMS is expected to provide resources and training to allow home health agencies to prepare and learn about the expectations and requirements of the expanded HHVBP Model without risk to payments. Agencies must be on the lookout for significant adjustments in the benchmarking process.

HHVBP Measures and Scoring

Essentially, home health agencies would receive a total performance score (TPS) based on their performance in comparison to their improvement score and other agencies’ performance (achievement score); the higher of the two would constitute the TPS. The baseline year used for the comparison starting January 2022 would be the agency’s performance in 2019. Improvement and achievement scores will determine whether the agency wins or loses up to 5% in dollars for 2022, which will be reflected in 2024.

Below are the quality measures that impact the calculation of the Total Performance Scores (TPS):

Next Steps to Take

It is best to be ready for the HHVBP expansion. Below are specific steps providers can take to prepare:

• Examine performance for the year 2019
• Compare 2021 scores to the baseline year of 2019 to gauge improvement score
• Compare 2021 scores to the national scores for 2019 (benchmark) to gauge achievement score
• Identify measures that need the most attention
• Develop a performance improvement plan to address them
• Set targets for improvement and track monthly

Gather your scores for the measures above. The calculation of these scores is available via your partner for quality outcome measurement, or via agency VBP reports if you are currently in a VBP state.

Leveraging QA

With these changes, it is important to enlist help as much as you can to take advantage of the incentives from the HHVBP program. Home health agencies must leverage their QA to optimize their scores on the set quality measures. Your QA review program can significantly help improve and maintain the quality of your patient care documentation. QA providers can contribute helpful insights on areas that require improvement, as well as provide support in other aspects, such as reeducation of clinicians on more complex issues.

Harness HHVBP to Your Advantage

HHVBP is a challenge and an opportunity for agencies at the same time. While it is intended to drive savings in Medicare utilization of healthcare services, it also provides incentives for home health agencies that deliver quality patient care. With the right approach, HHVBP can inspire business growth for home health agencies while also stimulating excellent healthcare services. It is an opportune time to explore growth opportunities that also lay the groundwork for quality patient care to flourish.

The post Gearing Up for HHVBP National Expansion: Where to Begin first appeared on Qavalo.

The Centers for Medicare & Medicaid Services (CMS) recently released the 2022 home health final payment rule. The highlight of which is how agencies nationwide will soon be subject to the Home Health Value-Based Purchasing (HHVBP) Model, which is recognized as one of the most successful alternative payment models ever.

According to CMS, the goal of the final rule is “to improve home health care for older adults and people with disabilities through a final rule that would accelerate the shift from paying for Medicare home health services based on volume to a system that pays for value.”

We have summarized the most important updates in the final rule, which include:

• HHVBP national expansion
• Increase in Medicare payments to home health agencies (HHAs)
• Conditions of Participation (CoPs): Making current blanket waivers permanent
• Occupational therapy (OT) low utilization payment adjustment (LUPA) add-on
• Changes in PDGM calculations

HHVBP National Expansion

In the final rule for CY 2022, CMS is expanding the HHVBP Model nationwide so the program is no longer limited to the original nine states where it was first implemented in 2016. The first performance year of the expanded HHVBP Model will be CY 2023; quality performance data from that year will be used to calculate payment adjustments under the expanded Model in CY 2025. Throughout 2022, CMS will provide technical assistance to HHAs to ensure they understand how performance will be assessed as finalized in this rule.

Increase in Medicare Payments to HHAs

The CY 2022 home health payment update percentage is 2.6 percent, which is an increase of $465 million. Considering the effects of the updated fixed-dollar loss ratio and the changes in the rural add-on percentages for CY 2022, CMS estimates that Medicare payments to HHAs in CY 2022 would increase in the aggregate by $570 million (3.2 percent).

CoPs: Making Current Blanket Waivers Permanent

CMS is finalizing policies that make current blanket waivers related to home health aide supervision permanent, as well as the use of telecommunications in conducting assessment visits.

While CMS finalizes the use of telecommunications technology when performing the 14-day supervisory visit requirement when a patient is receiving skilled services, CMS also expects that in most instances, agencies would plan to conduct the 14-day supervisory assessment during an on-site, in-person visit, and that agencies would use the interactive telecommunications systems option only for unplanned occurrences that would otherwise interrupt scheduled in-person visits.

CMS is also updating the home health CoPs to implement provisions to permit an occupational therapist to conduct the initial home health assessment visit and complete the comprehensive assessment under the Medicare program, but only when occupational therapy is on the home health plan of care with physical therapy and/or speech therapy, and skilled nursing services are not initially on the plan of care.

OT LUPA Add-on

CMS maintains the CY 2021 LUPA thresholds for CY 2022 to pay more accurately for the types of patients HHAs are serving.

On the other hand, since OTs are now able to conduct the initial and comprehensive assessments, CMS is establishing a LUPA add-on factor for calculating the LUPA add-on payment amount for the first skilled occupational therapy visit in LUPA periods that occurs as the only period of care or the initial 30-day period of care in a sequence of adjacent 30-day periods of care. Currently, there is insufficient data regarding the average excess of minutes for the first visit in LUPA periods when the initial and comprehensive assessments are conducted by OTs. Therefore, CMS will utilize the physical therapy LUPA add-on factor as a proxy until CY 2022 data is available to establish a more accurate occupational therapy add-on factor for the LUPA add-on payment amounts.

Changes in PDGM Calculations

The final rule also confirms the recalibration of the PDGM case-mix weights. With the 432 case-mix groupings, about half of them have increased in case-mix weight and about half of them have decreased.

Furthermore, there are also changes in the scoring of functional levels and an expansion of the comorbidity groups. Agencies should make sure to check out all the details of these changes to the PDGM calculation to understand how it is going to impact agency reimbursements.

Make Changes Work for You

With the home health landscape constantly updating, it is crucial to stay on top of the changes. It will be strategic to have a reliable partner that can help you interpret how exactly the changes will affect your operations, especially in terms of avoiding setbacks or in leveraging the changes to your agency’s advantage. The right partner should employ integrated staffing solutions to take charge of your back office functions making sure new regulations are implemented in your workflows and accurately reflected in the documentation. This will allow your in-house team to deliver undisrupted patient care and pursue more business growth opportunities.

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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:

1. Quality of Patient Care – based on OASIS assessments and Medicare claims data
2. 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:

1. Using incentives to improve care
2. Tying payments to value through new payment models
3. 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:

1. Educate clinicians with the HH CAHPS survey questions and the answer options. Once topics are identified, focus on improving these areas.
2. 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.

Resources:
CMS.gov: Home Health Quality Reporting Program
CMS.gov: Home Health Quality Measures

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What Is Value-Based Care?

According to the Centers for Medicare and Medicaid Services (CMS), value-based care is the concept of “paying providers based on the quality, rather than the quantity of care they give patients.” Its goal is to improve clinical practice and patient outcomes.

Value-based care is a payment model that rewards providers when they help patients improve their health, reduce the impact of chronic disease, and live healthier lives. It has emerged as an alternative replacement for the fee-for-service model, which pays providers for the amount of services that they deliver. This has incentivized many providers to request more procedures, as well as manage more patients to improve profit margins. Cost for procedures increased and the home health industry was spending more to treat patients even though patient outcomes were not necessarily improving.

What It Means for Patients

Since value-based care incentivizes improvements in patient outcomes and the quality of care that patients receive, it triggers a shift in the mentality of home health providers in how they deliver care. Their new goal is to standardize healthcare processes through best practices. Using data and evidence, providers can determine which processes work and which don’t. This forms a foundational “care pathway” to help get best results for patients.

Patients benefit from this in terms of wellness, prevention, and less hospital readmissions. This quality-over-quantity payment model is all about being proactive rather than reactive. Preventive care reduces the need for more procedures and interventions, thus cutting healthcare costs for everyone. Patients staying well and healthy results in fewer hospital readmissions and trips to the emergency room.

What It Means for Home Health Providers

While value-based care is being adapted to improve patient care, we cannot deny the reality that it poses a challenge for care providers to optimize their business profitability under this new concept.

Aside from improving care delivery and outcomes, providers will simultaneously be challenged to improve their ways of documenting and reporting patient care and progress as these will be the main basis of payment. Value-based care reimbursements are calculated by using numerous measures of quality and determining the overall health of patients. Providers must report to payors on specific metrics and show improvement by tracking and reporting on hospital readmissions, adverse events, care plan follow-through, patient engagement, and more.

Value-based care compels providers to use evidence-based processes, engage patients, upgrade health IT, and use data analytics in order to get paid for their services. When patients receive more effective care, providers are rewarded.

Focus on Coding and Documentation

The transition for home health providers to value-based care is not easy because traditional business models have yet to catch up. There is a lack of complete and robust data, and the reality is that accurate diagnostic coding and quality reporting can be labor-intensive and time-consuming. These factors can be hurdles in providing the best care possible for patients.

Home health providers can align with the goals of value-based care and still optimize profitability by utilizing the right tools and partnering with the right solutions provider. These can help capture and process data to make them actionable insights that enable home health agencies to identify and prevent problem areas, and recognize opportunities for process improvement.

Coding and documentation are the languages of our healthcare ecosystem. If the documentation is incomplete or inaccurate, revenues under value-based contracts can be severely impacted, and worse, patients may not get the care they need. Proper documentation is not simply good practice; it is critical for value-based care.

The Bigger Picture

Value-based care is no longer a long-term goal. It is a clear and present push from both CMS and private insurers to align healthcare payments with better healthcare outcomes and most importantly, improve overall health and well-being.

The transition to value-based care may not be smooth, but if done correctly, it can benefit the entire healthcare ecosystem, including patients, providers, and payors alike. Simply put, everyone wins.

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