CMS proposed significant changes to the Home Health Prospective Payment System (Home Health PPS).
The rule includes steps to implement the Patient-Driven Groupings Model (PDGM), a new case-mix, value-based payment system for home health agencies that ties Medicare reimbursement to patient characteristics rather than the number of therapy visits.
Key takeaways include:
- Medicare payments to home health agencies are expected to increase 2.2% ($420 million) next year
- Remote patient monitoring has stronger support under new rule changes
- Regulatory burden reduction one of the central themes of the home health rules
- Greater opportunity for home health service organizations to engage with payer/provider organizations to deliver value-based care and meet the needs of patients.
In January 1, 2016, the CMS Innovation Center implemented the Home Health Value-Based Purchasing (HHVBP) Model. This new model was designed to support greater quality and efficiency of care among Medicare-certified Home Health Agencies (HHA) across the nation.
The HHVBP Model leverages the successes of and lessons learned from other value-based purchasing programs and demonstrations to shift from volume-based payments to a model designed to promote the delivery of higher quality care to Medicare beneficiaries. The overall purpose of the HHVBP Model is to improve the quality and delivery of home healthcare services to Medicare beneficiaries with specific goals to:
- Provide incentives for better quality care with greater efficiency
- Study new potential quality and efficiency measures for appropriateness in the home health setting
- Enhance the current public reporting process.
The HHVBP Model will be implemented among all HHAs in nine states representing each geographic area in the nation. All Medicare-certified HHAs that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will compete on value in the HHVBP model, where payment is tied to quality performance. HHAs in these nine states will have their payments adjusted in the following manner:
- a maximum payment adjustment of 3% (upward or downward) in 2018,
- a maximum payment adjustment of 5% (upward or downward) in 2019,
- a maximum payment adjustment of 6% (upward or downward) in 2020,
- a maximum payment adjustment of 7% (upward or downward) in 2021,
- a maximum payment adjustment of 8% (upward or downward) in 2022.
“This model is designed so there is no selection bias, participants are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified HHAs nationally,” says Dominic Galante, MD, MS, chief medical officer, Access Experience Team at Precision for Value.
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In 2019, for example, home health providers in the participating states were exposed to a maximum adjustment of 5%. In 2020, that adjustment rises to 6%, with a 1% annual increase in 2021 and 2022, he says. “For calendar year (CY) 2020, CMS is proposing to publicly report Total Performance Scores (TPS) and TPS Percentile Ranking for each home health agency in the nine model states that qualified for a payment adjustment. The agency expects that data to then be made public after December 1, 2021.”
“CMS is moving forward with many of the provisions originally included in the PDGM while also proposing to implement a new home infusion benefit, eliminate home health pre-payments and make Value-Based Purchasing Model (VBPM) performance data public,” says Galante. “Overall, CMS’s proposed rule for 2020 includes updates that would increase Medicare payments to home health agencies by 1.3%—or about $250 million.”
Most notably is CMS’s ambitions to phase out pre-payments for home health services, Galante says. “Currently, home health providers can obtain 50% to 60% of the anticipated payment at the beginning of a patient’s care episode through a Request for Anticipated Payment (RAP),” he says.