In 2025, there will be significant changes implemented for the Home Health Value-Based Purchasing model. These changes aim to improve the program’s effectiveness in assessing and incentivizing quality care delivery in home health services. It is important for home health agencies to be aware of these changes and understand how they may impact their operations.
It’s crucial to note that although the proposed changes to the Home Health Value-Based Purchasing model won’t officially take effect until 2025, the baseline year for these modifications will be 2023, the current year. Therefore, it is essential for us to start familiarizing ourselves with these new measures and prioritizing our education to prepare for what lies ahead in 2025. This early preparation will allow us to adapt effectively to the upcoming changes.
PROPOSED CHANGE #1 – REMOVAL AND REPLACEMENT OF MEASURES, INCLUDING DISCHARGE TO COMMUNITY
Under the proposed changes, the Home Health Value-Based Purchasing (VBP) model will see the removal of five measures currently in place and their replacement with three new measures. One of the measures to be removed is the Discharge to Community measure, which is presently based on OASIS. It will be substituted with a Discharge to Community Post-Acute Care measure that utilizes claims data. This new measure will assess the number of patients who, after being discharged from Home Health, do not require hospitalization or do not pass away within 31 days of their return to the community. It is important to note that there will be exclusions for certain cases which can be reviewed here.
PROPOSED CHANGE #2 – INTRODUCTION OF THE POTENTIALLY PREVENTABLE HOSPITALIZATION (PPH) MEASURE
In the next upcoming change to the Value-Based Purchasing model, the Home Health Within-Stay Potentially Preventable Hospitalization (PPH) measure will be introduced. To review the details of this proposed change, click here. This measure has already replaced the Acute Care Hospitalization and the Emergency Department measures in the Home Health Quality Reporting Program. Now, it will also replace these measures in the Value-Based Purchasing model. The introduction of this measure aims to assess and reduce the occurrence of potentially preventable hospitalizations and observation stays during a patient’s stay in home health care.
PROPOSED CHANGE #3 – REPLACEMENT OF THE TOTAL NORMALIZED COMPOSITE CHANGE IN MOBILITY AND CHANGE IN SELF-CARE MEASURES
Lastly, the Total Normalized Composite Change in Mobility and Change in Self-Care measures will be replaced with a single Discharge Function Score. This new score will be based on GG items, whereas the previous measures were based on M1800 items. This change aims to streamline the assessment process and provide a more comprehensive evaluation of a patient’s functional abilities at the time of discharge.
The inclusion of GG items in the OASIS data set marked a clear transition where they eventually replaced the M1800 items. This regulatory language signifies the initial steps towards the replacement of M1800 items with GG items.
The calculation for the Discharge Function Score using GG items will involve taking your responses at the Start of Care or Resumption of Care and running them through an algorithm. This will generate an estimated Discharge Function Score based on your initial assessment of the patient. Once your discharge OASIS is filed, the responses will be compared to the estimated Discharge Function Score. The measure will then be calculated based on whether your actual discharge responses match or exceed the original estimated discharge function score.
Understanding how the calculation will be done is crucial, and it is important to promptly assess the education provided in your organization regarding GG items. This includes evaluating what your field staff are currently being taught and identifying any additional education required to ensure that field staff completing OASIS, and QA staff reviewing OASIS, understand how to accurately complete the GG items. Taking these steps will contribute to a better understanding and implementation of GG items within your organization.
The GG items will be solely responsible for calculating the Discharge Functional Score in the Value-Based Purchasing model. This measure alone will account for 20% of your Total Performance Score in Value-Based Purchasing.
If you require any assistance or have questions regarding GG item education or the Home Health Value-Based Purchasing expansion, please feel free to reach out to Healthcare Provider Solutions.
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