The Centers for Medicare and Medicaid Service (CMS) finalized all of the proposed changes to the Value-Based Purchasing (VBP) Model for implementation January 1, 2019.

One of the refinements of VBP removed five measures, while adding two new composite measures. OASIS based process measures “Influence Immunization Received for Current Flu Season” and “Pneumococcal Polysaccharide Vaccine Ever Received” were removed completely, while “Improvement in Bathing,” “Improvement in Bed Transferring” and “Improvement in Ambulation-Locomotion” were replaced by two normalized composite measures that use the aforementioned measures in the composite calculations:

    1. Total Normalized Composite Change in Self-Care, which computes the magnitude of change based on a normalized amount of possible change for the following measures:
      • Improvement in Grooming
      • Improvement in Upper Body Dressing
      • Improvement in Lower Body Dressing
      • Improvement in Bathing
      • Improvement in Toileting Hygiene
      • Improvement in Eating
    2. Total Normalized Composite Change in Mobility, which computes the magnitude of changes based on a normalized amount of possible change for the following measures:
      • Improvement in Toilet Transferring
      • Improvement in Bed Transferring
      • Improvement in Ambulation/Locomotion

Also, note that the composite change measures will be calculated using a 2017 BASELINE year. While the VBP model was established and continues to be based on a 2015 baseline year for all other outcome calculations, these will be based on 2017.

In addition to removing and adding measures, the changes also include a reduction to the amount of improvement points an agency can earn in the value-based purchasing model, another factor taken into account for payment adjustments. CMS has made it clear that the agencies that started VBP with really low scores have, basically, had time to catch up, so these changes include a plan for there to be “a slightly stronger focus on achievement.” The massive scores from Improvement alone will be no longer.

CMS has recalibrated the weighting for measures that are OASIS based, claims based and HHCAHPS based. For the first three years of VBP, the measures were weighted the same for the purposes of payment adjustment. In the overall calculation of the Total Performance Score (TPS), 2019 has brought changes that include the following weights for the four measure categories:

  • OASIS Based measures: 35%
  • Claims-based measures: 35%
  • HHCAHPS measures: 30%

If an agency did not have enough volume to support calculations in any of the above categories the remaining categories would be increased proportionally. CMS notes that OASIS based measures have been steadily improving, while claims based measures have been flat. CMS is expecting that by increasing the weight of claims based measures agencies will be encouraged to focus on improvement in those areas.

The significance of these changes will not be felt until agencies begin receiving the VBP reports for first quarter 2019. Agencies should be monitoring their CASPER reports and following the outcome calculation changes as closely as possible.