Hello everyone, and welcome to our Monday Minute. Today I want to share some quick information on the coming implementation of the Value-Based Purchasing Nationwide Rollout that is set to be effective January 1, 2023.
With the implementation of this Nationwide Rollout, as we’ve discussed in this Minute before, and many of you are aware, the Value-Based Purchasing model was a demonstration over the course of five years that was active in nine states. Within those nine states, the Value-Based Purchasing model was pretty much implemented in its last two years with the same parameters that will be in this Nationwide Rollout with a couple of exceptions.
The new measures or extra measures, what I like to call them, that agencies were responsible for self-reporting in the Value-Based Purchasing portal will not be included in the Value-Based Purchasing Nationwide Rollout. In addition to that, there’s going to be a couple of changes in the Acute Care Hospitalization and Emergency Room department measure. Both will be eliminated from the home health outcome calculations effective January 1, 2023 and will be replaced with the Home Health Within Stay Potentially Preventable Hospitalization measure, which includes Preventable Hospitalizations as well as Preventable Observations that occurred during a home health stay. We will provide the link to the actual calculation definition and how this new measure is calculated in the Minute today.
With the Value-Based Purchasing Nationwide Rollout, a couple of key components to remember is that every agency in the Nation that’s Medicare-certified will be required to participate, assuming you did not become Medicare certified in 2022. If your Medicare certification date is 2022, you will not participate in Value-Based Purchasing until 2024. If that does not include you, then you will participate in Value-Based Purchasing. If you have enough patients that you’re required to participate in the HHCAHPS survey process, you will be in the large cohort, any agency small enough that is not required to participate in HHCAHPS will be in the small cohort. Within the calculations, every agency within the corresponding cohort will be compared to every other agency in that same cohort.
We will also provide a link today to the Value-Based Purchasing page of the CMS website. For your reference that includes a fact sheet and checklist and some of the key components and elements that are going to be included in Value-Based Purchasing.
There are three specific categories of calculations that will take place to get to your Total Performance Score (TPS):
1- Questions from the OASIS document
2- Includes this preventable hospitalization measure I just mentioned.
3- Includes five key outcome measures directly calculated from the HHCAHPS survey responses.
It is imperative that if you have not been involved in Value-Based Purchasing through the demonstration, someone within your organization begins to unpeel the pieces to the process in understanding where your agency stands. When this becomes a Nationwide situation your Total Performance Score is calculated, it is then put into the basket, for lack of a better term, with all the other agencies in your cohort and a calculation that’s called the Linear Exchange Function (LEF) is then applied. This will determine where you will be in the process of calculating whether you’ll receive a positive, as far as reimbursements concerned, or they will take money in the form of a negative. You technically could be right at zero, but it’s likely that you will have some positive to be added to your payments in future years or some negative to be taken away.
Some of the key elements again, OASIS completion that includes functional items and some other items. It includes the preventable hospitalization measure, and it includes your HHCAHPS surveys.
In the Minute over the next few weeks, we will peel apart some of these specific categories that will be used in the calculation of Value-Based Purchasing and hope that this will find you preparing for the onslaught of its implementation.
Thank you so much for participating today. Please stay connected to your State and National Home Care and Hospice associations, as I know they are planning Value-Based Purchasing education that will be very valuable to your agencies. I hope you have a fabulous week and thank you for being out there on the frontlines taking care of patients.
https://innovation.cms.gov/innovation-models/home-health-value-based-purchasing-model