With Home Health Rule Unveiled, All Eyes are on HHVBP

McKnight's Home Care | By Liza Berger

A big exhale seemed to sound from the industry last week after the release of the final Medicare home health rule. No question the measure was imperfect, but it helps clear the way for firms to make plans and prepare for other regulatory changes. And of the latter, there are some big ones, including the start of the Home Health Value-Based Purchasing (HHVBP) model, which goes live nationally Jan. 1.

Not unlike the home health rule, there is much anticipation for the HHVBP model, which is based on how well an organization ranks compared  to its peers. Under the expanded initiative, home health agencies receive adjustments to their Medicare fee-for-service payments based on their performance against a set of three quality measures relative to their peers’ performance: Data from Outcome and Assessment Information Set (OASIS), completed Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys and claims-based measures.

The Centers for Medicare & Medicaid Services has been bullish on this model ever since it tested it in nine states starting in 2016. The original model resulted in an average of 4.6% improvement in HHAs’ total performance scores and an average savings of $141 million to Medicare. Evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending.

Understandably, the home health industry has voiced reservations toward the national expansion of HHVBP. Due to feedback from provider groups such as the National Association for Home Care & Hospice, CMS delayed the start of HHVBP to 2023. In the recent home health rule, CMS established 2022 as the baseline line. 2025 is the first payment year for the program.

The program symbolizes the ethos of healthcare at the moment: paying for value as opposed to volume, focusing on quality and savings, and keeping people out of the hospital. As companies and consultants continue to remind us, if you are not yet on board the value-based care bus, it’s time to purchase a ticket. Learn more about HHVBP and how to prepare for it.

CMS Care Compare to Offer More New Information on Home Health-Physician Relationships

Home Health Care News | By Andrew Donlan

Care Compare – the all-in-one search tool for consumers seeking home health, hospice and other Medicare-reimbursed health care services – will now include new information on providers’ relationships with doctors and clinicians.

The U.S. Centers for Medicare & Medicaid Services (CMS) announced the update on Monday.

According to CMS, the new update is meant to “provide additional information to support patients and caregivers as they make health care decisions.” The update, the agency noted, will also offer “information about clinicians who aren’t affiliated with a hospital but work in other types of health care facilities.”

Specifically, the update will be found under the “Doctors and Clinicians” section on Care Compare.

In addition to showing Medicare beneficiaries and their families which home health and hospice providers physicians are linked to, the update will include details on affiliations with skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), in-patient rehabilitation facilities (IRFs) and dialysis facilities.

Broadly, the update is part of CMS’ effort to make Care Compare more transparent and seamless across the major health care settings.

Prior to the Monday announcement, one of the most recent changes to Care Compare was adding Medicare-certified nursing home ownership data to the tool. In April, CMS also released data publicly – for the first time ever – on mergers, acquisitions, consolidation and changes of ownership for hospitals and nursing homes enrolled in Medicare.

“We’re taking another major step forward in improving transparency in health care,” CMS Administrator Chiquita Brooks-LaSure said at the time.

Adding insight on physician and clinician affiliations comes roughly 2 years after CMS consolidated all its different “Compare” tools into today’s one-stop shop. Originally, there were seven different Compare sites for the various Medicare-reimbursed health care settings.

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The Hospice Action Network is Recruiting New MyHospice Ambassadors for the 118th Congress. 

MyHospice Ambassadors are HAN's premiere, highly skilled advocates, who build and maintain significant long-term relationships with Members of Congress and their staff. 

We are seeking nominations of hospice advocates living or serving patients in all areas, especially those living or serving patients in the following states: Wisconsin, Nebraska, Arizona, and West Virginia. We are also seeking Ambassadors in the districts of Representative Morelle (NY-25/Rochester), Blumenauer (OR-03/Portland) and Sewell (AL-07).  Serve a different area? Don't let that stop you from applying!

MyHospice Advocates demonstrate: 

Passion 

Someone who has worked in and been a part of the hospice and palliative profession for a sufficient amount of time. During their tenure, this person has shown an outstanding dedication to their work and the patients they serve. This individual understands and can articulate the true value of hospice. 

Dedication 

Someone interested in expanding their commitment to the broader hospice and palliative care community by being a representative and a voice for person-centered care in their state through advocacy and federal policy outreach. 

Leadership 

Someone who exhibits leadership on their team and in their community and is willing to grow their position and develop their professional capabilities. This individual is ready to create and develop an on-going relationship with members of Congress and other community leaders. Someone who can step up and lead on advocacy efforts with the guidance and support of the HAN team- including organizing and hosting a local congressional meeting and attending annual fly-in events with other MyHospice Ambassadors. 

Think you have what it takes, or know someone who does?

Click to Apply to be a MyHospice Ambassador by Friday, December 2, 2022. 

After Hospital Discharge, Slow Home Health Care Initiation Increases Risk of Rehospitalization

American Journal of Managed Care | By Jared Kaltwasser

Patients discharged from the hospital are at a higher risk of re-hospitalization if they experience a delay in post discharge home health care initiation, according to a new study.

The study, published in Journal of the American Medical Directors Association, shows the risk of a re-hospitalization or emergency department (ED) visit jumps by 12% when patients wait more than 2 days for their at-home care to start.

More than 6 million Americans receive home health care each year, noted the study’s authors. In many cases, those home visits follow discharge from a hospital. Home health care providers can perform a range of services, including clinical assessments, wound management, and medication reconciliation, the authors said. Previous research shows that home health care visits following hospitalization can reduce the risk of readmission, especially for certain conditions, such as sepsis and heart failure.

CMS requires that initial at-home patient visits take place within 48 hours of referral or of the patient’s return home, unless otherwise stated by the patient’s physician. However, the investigators said no study has yet looked at whether the timing of such visits has an impact on patient outcomes.

They decided to examine the records of an urban home health care agency in the northeastern United States in order to see whether the agency’s success or failure in initiating care within 48 hours had a meaningful impact on patient outcomes.

The investigators analyzed a data set of 49,141 home health care visits received by 45,390 patients who were discharged from the hospital during 2019 and referred for at-home follow-up. They compared the timing of home health care initiation with 30-day hospitalizations and ED visits to see whether the timing affected outcomes and whether there were any disparities based on factors such as race/ethnicity, age, insurance type, and clinical status.

In total, about one-third of initial home health care episodes in the data set were delayed, meaning they did not happen within 48 hours. Previous research by the present study’s authors suggest that patients not answering the door or postponing visits were among the most common reasons for such delays.

Of those 34% of cases in which care was delayed, 14% of those delays resulted in a rehospitalization or ED visit within 30 days. And that translated into a 12% higher risk of rehospitalization or ED visit for patients whose home health care was not started within 2 days vs those who received timely initiation of home services.

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