Healthcare Provider Solutions



This Minute briefly reviews some of the highlights of Value Based Purchasing and what has been proposed.

Hello everyone, welcome to our Monday Minute. Today we are going to discuss Value-Based Purchasing, as most of you know, Value-Based purchasing has been proposed in the form of a nationwide rollout for home health beginning in January 2022. We’re relatively certain that this is going to transpire. So I wanted to share a few things with you very briefly today. We have some excerpts here from the annual report for the Value-Based Purchasing model. As you can see, with the information, there were nine states that participated in the Value-Based Purchasing model that technically was set to last for five years, which would have ended in December 2020. Technically, they’re not going to use any of the data from 2020 and ended the Value-Based Purchasing information at the end of 2019. In those four years of information, you can see that in the annual report, they’re telling us that $604 million was saved in the nine states alone, that they’re attributing to the Value-Based Purchasing demonstration. They’re saying that the majority of these funds that were saved was not taken out of the pockets of home health agencies but was due to a reduction in inpatient hospitalization stays, and a reduction of skilled nursing facility stays in those nine states. So using that data, they are now proposing that they would like to save that kind of money, which technically turns out to be about $150 million a year in wanting to roll that out nationwide. If they can save that much money, in any given year with nine states participating, what’s that going to look like when the entire nation has to participate. You can see on the screen that we have the exact measures that they’re currently proposing to be used in the rollout nationwide, OASIS items on the left, on the right the CAHPS information, and Claims data. This is very, very similar, if not exact information that was used during the Value-Based purchasing demonstration. Some tweaks were made to the VBP demonstration over the course of the four-year model, the most significant ones being in that fourth year, which would have been in the fifth year as well, but they cut it off because of COVID.

A couple of quick thoughts for those of you who have never been in Value-Based Purchasing before, there’s an achievement calculation and an improvement calculation. Achievement is based on the performance year, which will be 2022 compared to the achievement thresholds, which would have been data from what you had in 2019. We’re skipping 2020 completely, as far as Value-Based Purchasing is concerned. The maximum points you can receive for achievement is 10. And the improvement calculation, you can receive a maximum of 9 points. Once calculated is compared to your achievement score that we just looked at and whichever of those two calculations is the highest is the one that you will get for each of the measures in the overall total performance score calculation. This is one thing that you really need to pay attention to. This is all of the measures that we discussed earlier laid out with the percentage in All Measures column, the percentage of the impact that those individual measures will have on the total performance calculation. The thing you really need to see is that 26.25% of your total performance score will be based completely on acute care hospitalizations, obviously coming from claims data and another 8.75% is emergency department use. The combination of that being 35% of your total performance score, coming from acute care, hospitalization rates, and emergency room department use. I wanted to share that with you today to give you a little insight as to what the Value-Based Purchasing model is actually going to look like and we obviously still have some details missing. Some of the key calculation information still has to be obtained. The National Association for Home Care and Hospice is working on a strategic education plan, so stay tuned for that in educating the nation. In addition to that, HPS will have a webinar on September 17th to talk about as many of the details as we have so far. Thank you all for participating today. I hope you have a fabulous week, and we will talk again soon.