The Home Health Final Rule for 2024 that was published November 1, 2023 contained many changes – including ones that will specifically impact the Home Health Value-Based Purchasing Model in 2025.
The Value-Based Purchasing Model in 2023 will remain unchanged in 2024, with the baseline year of 2022 still in effect. However, many significant changes will occur once we reach 2025. Specifically, five outcome measures will be removed from the Model, while three new measures will be introduced in their place.
As a result of the new measures, weight adjustments to individual items will occur, influencing overall Total Performance Scores (TPS). Contrarily, HHCAHPS measures, how they are calculated, and their 6% impact on the Total Performance Score will remain completely unchanged.
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. In addition, a new OASIS measure titled Discharge Function Score (DFS) will be added to the model. This score will be solely based on items GG0130 and GG0170. From GG0130, only Eating, Oral Hygiene and Toileting Hygiene will be utilized in the calculation of this measure.
The existing OASIS-based Discharge to Community (DTC) measure will be substituted with a new measure titled Discharge to Community-Post Acute Care Measure (DTC-PAC), which will utilize claims data. This change will have a direct impact on the calculation for Value-Based Purchasing. Unlike the current measure, the new claims-based measure will use 2 years of data instead of only 12 months.
Furthermore, the Acute Care Hospitalization (ACH), and Emergency Department (ED) measures will no longer be included. Instead, these measures will be consolidated into a single measure known as the Potentially Preventable Hospitalization (PPH) Measure. The PPH measure, combined with the Discharged Community Post-Acute Care Measure, will constitute the claims data that will be utilized in the model.
The current Total Normalized Composite Change in Self-Care and Total Normalized Composite Change in Mobility measures, which rely on the 1800 items on the OASIS, will be eliminated. Instead, these measures will be substituted with the previously mentioned Discharge Function Score, which will be based on GG items.
The upcoming Value-Based Purchasing transformation will bring about a significant overhaul to our current model. As a result, it will require comprehensive education for your staff prior to 2025. In particular, we have observed through nationwide chart reviews and similar means that there has not been an equivalent level of education on the GG items compared to the ADL’s in the M1800 section. We strongly urge agencies to promptly initiate thorough education sessions for their staff members regarding the GG items on the OASIS. It is equally important to involve your QA audit team in these educational efforts to ensure that everyone is aligned on how these items should be completed. This understanding will be crucial in continuing to successfully navigate the Value-Based Purchasing Model.
When calculating the Discharge Function Score specifically related to the GG items, the information documented about the patient on the Start of Care or Resumption of Care OASIS will be utilized in the CMS, newly created, algorithm. This algorithm will calculate the expected discharge status of the patient, based on what was documented about the patient’s status on the SOC or ROC. After the agency submits their Discharge OASIS, the reported discharge status will be compared to the algorithm’s calculated discharge status. If the agency’s results are equal to or surpass the algorithm’s calculation, it will lead to a positive measure outcome for the Discharge Function Score.
As many believe there is a need for agencies to have access to the algorithm, confidence exists that many EMR systems are already working on this development since the algorithm was released with the Home Health Proposed Rule in July. Adapting to the changes in this Value-Based Purchasing Model will indeed be challenging, particularly because many agencies have not given enough emphasis to the GG items in the past.
Another required adjustment is to the replacement Potentially Preventable Hospitalization measure, which replaces the ACH and ED OASIS measures. The PPH measure includes Observation stays. Therefore, if your patient experiences an Acute Care Hospitalization or Observation stay while under Home Health care, it will have a negative impact on the measure outcome.
There is still much to be learned in the details of these Value-Based Purchasing changes, and Healthcare Provider Solutions will be addressing these changes in detail in the coming year. Should you need additional information, or have any questions about Value-Based Purchasing, please feel free to reach out to us.
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