The nationwide expansion of Value-Based Purchasing, which began on January 1, 2023, affects all Medicare certified agencies and has a dedicated web page on the CMS website, specifically linked to CMMI. You can register on the Value-Based Purchasing web page to receive monthly newsletters tailored to the expansion. Recently, an April newsletter was released, covering key data points to be discussed today, including updates to risk adjustment factors and modifications in the Home Health Quality Reporting program.
The PIPR has undergone three iterations, with the latest version released during the third week of April and accessible in the iQIES system, where you usually obtain your CASPER reports. PIPR reports display your current percentile ranking for each outcome measure in comparison to agencies nationwide that are part of your cohort in the live Value-Based Purchasing expansion calculations for 2023. The PIPR reports draw on data from the previous year and portions of 2022. Starting in July 2023, the implementation reports for 2023 will be released, featuring current achievement thresholds, and benchmarks from the baseline year of 2022, which will be employed in calculating the 2023 outcomes.
Reviewing the PIPR reports is crucial for grasping your organization’s standing relative to other agencies in specific outcome measures for the current year as the expansion progresses. If your individual measures rank at the 51st percentile or higher, you are likely to experience a positive outcome in the reimbursement impact calculation once all 2023 data has been gathered and calculated.
On the web page for the expansion, you’ll find a list of resources, two of which have been updated. These updated documents focus on risk adjustment, with one specifically addressing the risk adjustment factors that affect the calculation of Total Normalized Composite Change in Mobility and Self-Care Measure (TNC).
In the April newsletter, it’s important to mention that they address 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 is good news, and it’s essential to understand how it will affect your outcome measures.
If you have any further questions regarding this content or require any services from HPS, particularly in relation to Value-Based Purchasing, please feel free to get in touch.
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