CMS Plans Expansion of the Home Health Value-Based Purchasing Model in 2022

At the start of 2021, the Centers for Medicare and Medicaid Services (CMS) announced their intent to expand the Home Health Value-Based Purchasing (HHVBP) Model to states outside of the current nine who use the model. The HHVBP Model was introduced back in January of 2016 as a test to see if a monetary incentive would produce a higher quality of care and generate a positive impact to overall patient care. Currently, the model is used in the following states: Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska and Tennessee.

According to CMS, the decision to expand the model comes from the aftereffects of the COVID-19 pandemic. “The Coronavirus pandemic has tragically illustrated how important it is for elderly Americans to have a robust set of options outside of nursing homes,” said CMS Administrator Seema Verma in their press release back in January. “Nursing homes will always be an important part of the care continuum – especially for those who need an intensive level of care – but home health services are often preferred by seniors. Expansion of this model would improve the overall value and quality of that home health care – and seniors stand to benefit.” CMS strongly believes that expanding this model will ultimately improve patient care quality given their statistical findings from current states using this model. CMS reports a 4.6% improvement in home health agencies’ quality scores as well as average annual savings of $141 million to Medicare.

What does the HHVBP Model do for home health agencies?

CMS explains that the HHVBP Model adjusts payments to Medicare-certified home health agencies on the quality of care provided, rather than the volume of services rendered. Essentially, this model rewards or penalizes home health agencies for good or poor performance in patient care quality scores. For example, if a home health provider scores high in patient care quality for the year of 2020, then they could potentially receive a Medicare payment adjustment of 6%. On the other hand, if the agency were to have done a poor job delivering care, they could be given the same percentage as a penalty.

What could this mean for your agency?

Currently, there is no announcement to what extent the expansion will reach. However, if your agency happens to be in a state that’s included in the expansion; your agency could potentially make a profit just doing what it currently does. You could be getting paid if your agency is performing well in patient care quality scores relative to others in your state. If your agency is struggling to gain efficiencies to help your clinical teams provide the best care to patients, you may need to invest in outside services to assist your agency so you can get paid for delivering high quality care.

Does your agency need assistance?

Our team of experts at MHA are well-versed in what’s relevant now in the industry and can assist in improving your clinical processes to expand patient care and recommend best practices. Contact us to learn more:

193 views0 comments