Value-Based Purchasing: Preparing for Success Now and in the Future. Before We Get Started. About HEALTHCAREfirst

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1 Value-Based Purchasing: Preparing fr Success Nw and in the Future Mary St. Pierre, RN, BSN, MGA May 26, :00 pm CST / 3:00 pm EST Befre We Get Started Audi is thrugh cmputer speakers r select Use Telephne n Audi Pane t call in. All attendees are muted. Yu can ask questins via the GTWebinar Questin Pane thrughut the presentatin. Handut link can be fund in reminder & n the Handut pane in the GtWebinar Cntrl Panel. On-demand vide will be made available fllwing the webinar. Abut HEALTHCAREfirst Industry leader in Web-based sftware, utsurced services & advanced analytics fr hspice and hme health. We enable ur custmers t: Make timely and accurate decisins fr excellent patient care Adapt quickly t changing requirements and needs Autmate agency functins quickly & with high value 1 Value Based Purchasing...Preparing fr Success Nw and in the Future

2 Value-Based Purchasing (VBP) Value quality rather than quantity The Triple Aim Imprving patient experience, including quality and satisfactin (Better care) Imprving the health f the ppulatins (Healthier peple) Reducing the per capita cst f health care (Smarter spending) Natinal Business Calitin n Health s Value-Based Purchasing Cuncil (NBCH) Re-engineer health care delivery via effective valuebased purchasing Reward effective health care services and high perfrming health care prviders with: Imprved reputatins thrugh public reprting Enhanced payments thrugh differential reimbursements Increased market share thrugh purchaser, payer, and/r cnsumer selectin Elements f NBCH VBP Element One: Standardized Perfrmance Measurement Measurement shuld be able t answer the questin, Is care safe, timely, efficient, effective, equitable, and patientcentered? Element Tw: Transparency and Public Reprting Standardized perfrmance measures must be cnverted int useful, accessible infrmatin fr purchasers, payers, and cnsumers Element Three: Payment Innvatin Differential reimbursement, r pay fr perfrmance, Element Fur: Infrmed Cnsumer Chice Value Based Purchasing...Preparing fr Success Nw and in the Future 2

3 HHVBP Final Rule Final rule Final rule published: Nvember 5, Implement a HH Value-Based Purchasing (HHVBP) Mdel: beginning January 1, 2016 All Medicare-certified HHAs in selected states Participatin required Data reprting mandated Scring methdlgy defined Payment adjustments and methdlgy specified Basis fr HHVBP Mdel Gal: Tie quality t payment Link perfrmance t pprtunity and risk fr payment adjustment Imprve quality f hme health care t Medicare beneficiaries Imprve quality and efficiency (test fr statistical significance) Affrdable Care Act President s Budget Secretary s refrm gal using alternative payment mdels: Tie 30% f fee-fr-service payment t quality by end f 2016 Tie 50% f fee-fr-service payments t quality by end f 2018 Tie 85% f traditinal Medicare payment t quality by 2016 Tie 90% f traditinal Medicare payment t quality by 2018 HHVBP: Overview Five perfrmance years Intended results Incentivize HHAs: better care/greater efficiency Study new measure in hme health setting Enhance public reprting prcesses Mdeled after Hspital VBP HH P4P Demnstratin Quality measures Aligned with Natinal Quality Strategy (NQS) pririties Value Based Purchasing...Preparing fr Success Nw and in the Future 3

4 HHVBP Prcess Assess perfrmance & adjust payment Five perfrmance reprting years: First year: 2016 Final year: 2020 (unless mdified thrugh later rule) Payment adjustment years (up r dwn) CY 2018: 3% CY 2019: 5% CY 2020: 6% CY 2021: 7% CY 2022: 8% Reprts fr Participating Agencies Quarterly perfrmance reprt Annual payment adjustment reprts Annual publicly available perfrmance reprts State Selectin Designed t: Avid selectin bias Be representative f hme health agencies natinally All HHAs receiving Medicare payment in MA, MD, NC, FL, WA, AZ, IA, NE, TN All Medicare patients served (including in reciprcal states) Agencies assigned t chrt based n CAHPS participatin Larger vlume chrt: cmpeting in CAHPS Smaller vlume chrt: exempt frm CAHPS (fewer than 60 HHCAHPS-eligible patients Value Based Purchasing...Preparing fr Success Nw and in the Future 4

5 HHVBP Mdel Plan Evaluate agencies perfrmance fr care t Medicare beneficiaries Achievement Imprvement Initially: Starter set selected fr year ne Quality measures OASIS CWF CAHPS New Measures Future: additinal measures based n IMPACT Act HHVBP Mdel Framewrk Six pririties int fur HHVBP Measure Classificatins: Classificatin I: Clinical Quality f Care Classificatin II: Care Crdinatin and Efficiency Classificatin III: Persn/Caregiver-Centered Experience Classificatin IV: New Measures Applicable Measures Applicable measure Measure fr which the cmpeting HHA has prvided 20 hme health episdes f care per year Benchmark Tp decile f HHA perfrmance n specified quality measure during the baseline perid Calculated separately fr larger vlume and smallervlume chrts in state Value Based Purchasing...Preparing fr Success Nw and in the Future 5

6 Minimum Number f Cases HHVPB participatin mandatry Ttal pints calculatin based n measures reprted New measure reprting required N scre fr Outcme & Clinical Quality measure 20 r fewer episdes per year N payment adjustment (except 10% New Measure adjustment) If n scre fr 5 r mre f quality measures Clinical Quality f Care Care Crdinatin & Efficiency Persn and Caregiver-Centered Experience Measure Selectin Objectives Use brad measures that capture HH cmplexity Allw flexibility fr inclusin f IMPACT measures Enable develpment f secnd-generatin measures Ensure balance f prcess, utcme, patient experience Advance the ability t measure cst & value Add measures fr apprpriateness r veruse Prmte infrastructure investments Final Measure Selectin Measures Prcess 10 Outcme 5 HHCAHPS 3 New Future Measures in 2017 per IMPACT Act Value Based Purchasing...Preparing fr Success Nw and in the Future 6

7 Perfrmance Benchmarks & Threshlds Achievement Pints and Imprvement Pints By chrt (Large/Small) Fr each measure Based n Achievement scale between threshld and benchmark Threshld: median f HHA s perfrmance during baseline perid Benchmark as tp decile f all HHAs perfrmance Imprvement: Pints alng imprvement range f change during perfrmance perid and baseline perid Perfrmance Scring Methdlgy Perfrmance scring methdlgy (20 r mre episdes) Determine perfrmance standards (benchmarks and threshlds) using the 2015 baseline quality data Scre HHAs based n their achievement and/r imprvement fr each measure Weight each classificatin by the number f measures emplyed Measure Weighting & Scring Methd Weighting New Measures: Based n reprting Accunt fr 10% f ttal scre Outcme, Prcess, HHCAHPS measures: Ratinale: Accunt fr 90% f ttal scre Each weighted the same At individual measure level (nt classificatin) Varying needs f individual agency ppulatins Prmte imprvement fr all, nt just higher weighted measures Value Based Purchasing...Preparing fr Success Nw and in the Future 7

8 Achievement Scring Achievement Scring Perfrmance equal t r higher than benchmark Maximum 10 pints Perfrmance equal t r greater than perfrmance threshld but lwer than benchmark 1-9 pints Perfrmance less than achievement threshld 0 pints Imprvement Scring Perfrmance equal t r higher than the benchmark scre Maximum 10 pints Perfrmance greater than baseline perid scre but belw the benchmark 0 10 pints if within the imprvement range 0 pints if equal t r lwer than baseline perid scre Ttal Perfrmance Scring Using higher f an HHAs achievement r imprvement scres fr each measure Runded up r dwn t the third decimal Quarterly basis Value Based Purchasing...Preparing fr Success Nw and in the Future 8

9 Perfrmance Scring Ttal Perfrmance Scre Numeric scre ranging frm 0 t 100 awarded t each cmpeting HHA based n its perfrmance Starter set: quality measures (20 r mre episdes) 90% f the TPS equal weight t all measures in ~ Clinical quality f care ~ Care Crdinatin and efficiency ~ Persn and Caregiver centered experience New measures 10% equal weight t Payment Adjustment Methdlgy Payment Adjustment CMS will determine a payment adjustment up t the maximum applicable percentage Upward r dwnward Fr each cmpeting hme health agency Based n the agency s Ttal Perfrmance Scre Using a linear exchange functin Adjustments will be calculated as a percentage f therwise applicable payments fr hme health Payment Adjustment Adjustment t maximum applicable percentage fr year Using Linear Exchange Functin (LEF) Ex: Slpe f LEF fr CY 2016: estimated aggregate value-based payment adjustments equal t 3-percent f the estimated aggregate base perating episde payment amunt fr CY 2018 Up r dwn t 3% Based n Ttal Perfrmance Scre (TPS) Calculate percentage f HH payments Multiply HH Prspective Payment final claim payment by payment adjustment percentage Value Based Purchasing...Preparing fr Success Nw and in the Future 9

10 Preview & Recalculatin Requests Quarterly Perfrmance Reprt Ntify HHA f quarterly perfrmance n quality measures 30 day preview by HHA ~ Submit request fr recalculatin and specific basis fr recalculatin if disagree Annual TPS and payment adjustment reprt Ntify in August in August previus year 30 day preview by HHA ~ Submit request fr recalculatin and specific basis fr recalculatin if disagree Review by CMS fr apprval r denial f request As sn as administratively pssible Appeals in accrd with prcess under develpment Clinical Quality f Care Measures Outcmes Imprvement ambulatin (M1860) Imprvement transfer (M1850) Imprvement bathing (M1830) Imprvement dyspnea (M1400) Prcess Drug educatin n all medicatin prvided t patient/caregiver during an episde f care (2015) Cmmunicatin/Care Crdinatin Outcme Discharge t cmmunity (M2420) Prcess Care management: Types & surces f assistance (M2102) Value Based Purchasing...Preparing fr Success Nw and in the Future 10

11 Efficiency and Cst Reductin Outcme Acute care hspital unplanned during first 60 days (CCW) Emergency department w/ hspitalizatin (CCW) Patient Safety Outcme Imprvement pain (M1242) Imprvement management f ral meds (M2020) Prir functin ADL/IADL (M1900) Ppulatin/Cmmunity Health Prcess Influenza data cllected (M1041) Influenza immunizatin received seasn (M1046) Pneumcccal vaccine ever received (M10510 Reasn pneumcccal nt received (M1056) Value Based Purchasing...Preparing fr Success Nw and in the Future 11

12 Patient & Caregiver Experience CAHPS Outcme (Q 2, 3, 4, 5, 9, 10, 12, 13, 14, 15, 16, 17, 18, 19, 22, 23, 24) Care f patients Cmmunicatin between prvider/patients Specific care issues Glbal type measures Overall rating HHA Willingness t recmmend HHA Hme Health Agency Gal Delivery f Quality Care thrugh Applicatin f standards f practice t yield Cmpliance Better utcmes Client/caregiver satisfactin Cmpetitive psitin in the cmmunity Cmpensatin Imprvement Prcess Plan, Crdinate, Deliver Establish gals Identify strategies Review results Regrup, rerganize, reestablish gals Research and incrprate new practices Value Based Purchasing...Preparing fr Success Nw and in the Future 12

13 Pilt and Nn-Pilt Agency Actin Fcus n the 24 quality metrics Hme Health Cmpare t establish a ballpark estimate f standing Review the CASPER reprts Cmpare the differences between these reprts and Hme Health Cmpare Immediately implement strategies t assess readiness Determine OASIS accuracy Prvide OASIS educatin Assess patient experience f care Cntinuusly mnitr reprts Identify and address trends and issues Develp plans t imprve scres Back t Basics Achievement f Gals Best practices Best staff Prtcls that align with gals Integratin with health care cmmunity Back t Basics Were gals different frm tday? Letter f gratitude: 1987 My nurse s qualities: cmfrting, reassuring, therapeutic Superb team leader wh assessed, planned, and crdinated all services ~ Supervised the aide ~ Oversaw rdering and care f equipment, xygen, medicatins, meal service Cmmunicated frequently with physician and family Value Based Purchasing...Preparing fr Success Nw and in the Future 13

14 #1 Pririty: Staffing Strive fr: mtivated, engaged, participatry, happy staff Determine desired staff qualificatins Recruit qualified persnnel Establish stable wrkfrce Orient all staff t hme health Educate n agency gals and missin Identify f errneus practices and cntinuusly advise f perfrmance Reward high perfrmers Cnduct nging staff training Changing clinical practices Individual and agency clinical utcmes Individual and agency CAHPS scres Back t Basics Leadership redesign Establishment f stable emplyee wrkfrce Optimizatin f perfrmance Develpment f staffs Ability Willingness Cnfidence Cmmitment Back t Basics: Imprvement Cnsideratins Key Cnsideratins in Care Delivery Frmal Care Management prgram Training: accurate and cmprehensive assessments Plan f care aligned t assessment Cmprehensive clinical actins (prcess, nt task) Regular, scheduled interdisciplinary meetings (in persn r virtual) Cnsistency in assignments/scheduling Accuntability fr patient gal management Cntinuus care: assessment, gal and plan mdificatin Patient/family/caregiver educatin prcess, tls, staff preparedness (the crnerstne f disease management) Value Based Purchasing...Preparing fr Success Nw and in the Future 14

15 Back t Basics: Imprvement Cnsideratins Identify clinicians with best utcmes Identify care delivery practices Apply agency-wide Establish crdinatin prcesses Require physician cmmunicatin, cllabratin and crdinatin Back t Basics: Imprvement Cnsideratins Resurces CMS VBP Tls and Assistance Hme Health Quality Imprvement Natinal Campaign Agencies/HHQI-Natinal-Campaign Nursing Practice/Patient Educatin Publicatins and Tls EHR embedded tls Care Planning tls ~ ~ Quality/QualityResurces/HmeHealthResurces_ReduceHs p.pdf ~ Patient Educatin: ~ MedStar VNA Key t Imprvement: The Nursing Prcess The Prcess: Nt the Task Assess Identify needs Establish gals Plan interventins Crdinate with team/physician Deliver care Reassess and Revise Value Based Purchasing...Preparing fr Success Nw and in the Future 15

16 The Key: Nursing Prcess Parallel Regulatry Requirements State Licensure Medicare Certificatin Regulatins: Hme Health Cnditins f Participatin Medicare Payment Regulatins: Qualifying and Cverage Rules The Key: Nursing Prcess Basic rule: Understand the multifaceted, cmpunding nature f care failure Failure t address medicatin management leads t: Increased pathlgy, uncntrlled symptms Overlked effectiveness failure, side effects, drug interactins ~ Dyspnea ~ Elevated BP, bld sugar ~ Weakness ~ Pain Emergency Department use and hspitalizatin Patient/caregiver dissatisfactin The Key: Nursing Prcess Basic rule: Understand the multifaceted, cmpunding nature f care failure Failure t address underlying pathlgy/needs leads t Increased weakness and pain, lead t Stabilizatin r decline in ~ Ambulatin ~ Transfer ~ Bathing Decline in ambulatin, transfer, bathing lead t Emergency Department Use and Hspitalizatin Patient/caregiver dissatisfactin Value Based Purchasing...Preparing fr Success Nw and in the Future 16

17 New Measures Submissin via Web-based platfrm Serves t cllect and distribute infrmatin frm & t HHAs New measures t be reprted Ppulatin/Cmmunity Health Influenza vaccine HHA persnnel Herpes zster vaccine: patients Cmmunicatin and Crdinatin Advance care plan (patient s desires if recvery imprbable) Advance Care Planning Percentage f patients aged 65 years and lder with medical recrd dcumentatin that Have an advance care plan r surrgate decisin maker, r Advance care plan was discussed, but patient Did nt wish, r Was nt able t name a surrgate decisin maker r prvide an advance care plan Data reprting beginning 10/7/16 Fr perid July 2016 thrugh September 2016 Quarterly thereafter Numeratr: Number f patients 65 and lder that have an advance care plan r surrgate decisin maker Denminatr: Number f patients 65 and lder admitted by agency Influenza Vaccine Cverage fr Persnnel Data Reprting Begin n later than 10/7/16 and quarterly thereafter Fr perid July 2016 thrugh September 2016 Numeratr by categry: number f persnnel wh: Received vaccine by agency r ther (written reprt), r Medical cntraindicatin, r Declined/Unknwn status, r Dn t meet definitin Denminatr: Number wh wrk at least ne day Octber 1 thrugh March 31 separately by categry Emplyee Independent practitiner (cntractr) Student/Trainee/Vlunteer) Value Based Purchasing...Preparing fr Success Nw and in the Future 17

18 Herpes Zster Vaccine fr Patients Data Reprting Begin n later than 10/7/16 and quarterly thereafter Fr perid July 2016 thrugh September 2016 Numeratr: ttal number f Medicare beneficiaries aged 60 and ver wh reprt having ever received herpes zster vaccine during the HH episde f care Denminatr: ttal number f Medicare beneficiaries aged 60 and ver receiving services Future Crss-Setting Measures IMPACT Act Requirement Timeline January 1, 2017 Measures t reflect all-cnditin risk-adjusted ptentially preventable hspital readmissin rates Resurce Use (t include ttal estimated Medicare spending per beneficiary) Payment Standardized Medicare Spending Per Beneficiary (MSPB) Discharge t cmmunity Percentage residents/patients at discharge assessment wh discharged t a higher level f care versus t the cmmunity Medicatin Recnciliatin Measure Percent f patients fr whm any needed medicatin review actins were cmpleted Hme Health Slutin Suite What s Included: Agency Management (EMR) Sftware Cding Services Billing Services Business Intelligence HHCAHPS Payer Cnnectivity Value Based Purchasing...Preparing fr Success Nw and in the Future 18

19 Hme Health Slutin Suite Benefits Maximize reimbursement while reducing verhead csts. Ensure regulatry cmpliance with accurate, cmplete and cmpliant clinical dcumentatin. Reduce yur risk f takebacks by submitting clean, errr-free claims. Grw and strengthen high-value referral relatinships. Simplify vendr management with ne expert business partner. Thank Yu On-demand vide will be made available fllwing the webinar. We want t hear frm yu! Please fill ut survey. Cntact HEALTHCAREfirst Value Based Purchasing...Preparing fr Success Nw and in the Future 19

20 Hme Health Value-Based Purchasing: Preparing fr Success May 26, When will Hemglbin A1C be required t be dcumented? Shuld we be ding that nw? Palmett GBA is the nly MAC currently requiring the reprting f HbA1c. The Lcal Cverage Determinatin (LCD) can be fund at L If Palmett is yur MAC, the requirement became effective 10/1/15, with the revisin effective 5/1/16. In rder fr Hme Health patients t be eligible t receive services under the Medicare Hme Health benefit the fllwing must be dcumented fr certificatin/recertificatin: Dcumentatin shuld shw that the patient is either physically r mentally unable t self-inject insulin and there is n ther persn wh is able and willing t inject the patient. The results f the mst recent HbA1c. Dcumentatin must be legible, relevant, and sufficient t justify the services billed. This dcumentatin must be made available t the A/B MAC upn request. 2. Baseline year is Is that fr all agencies r just the pilt agencies? CMS prpse t implement this mdel ver a ttal f seven years beginning n January 1, 2016, and ending n December 31, The baseline year wuld run frm January 1, 2015 thrugh December 31, 2015 and prvide a basis frm which each respective HHA s perfrmance wuld be measured in each f the perfrmance years. 3. I ttally agree that staffing is #1 pririty. Being that we are in the prcess f accreditatin and certificatin, we have had a hard time getting the right staff, especially since we have n patients fr them and its very cmmn fr them t wrk at many cmpanies. Any advice t hire gd emplyees when we are such an infant stage? Hme health agencies are required t prvide nly ne service directly (100% by emplyees). They have the ptin t select what that service will be. A new agency that is in the prcess f recruiting sufficient staff may wish t select ne f the smaller disciplines, such a scial wrk as their ne direct service. The agency wuld hire a scial wrker as an emplyee wh receives a W2 frm and have that emplyee prvide all needed scial wrk services. That will give them the flexibility t use all, r a mix f cntract wrkers and emplyees, fr nursing, hme health aide and therapy services until mre established and able t recruit full time emplyees.

21 4. Which 9 states are currently affected? All Medicare-certified HHAs that prvide services in Massachusetts, Maryland, Nrth Carlina, Flrida, Washingtn, Arizna, Iwa, Nebraska, and Tennessee participate in the HHVBP prgram. If yur hme health agency cares fr Medicare patients in ne f thse states yu shuld g t the fllwing website t register fr the mdel: HHAs included in the HHVBP Mdel are encuraged t take the fllwing steps: Establish yur Agency's HHVBP Pint f Cntact: HHAs in the nine selected states shuld prvide the HHVBP Help Desk, HHVBPquestins@cms.hhs.gv, with the name and address f a primary pint f cntact fr each CMS Certificatin Number (CCN). Please als include the Agency name, Agency address and Agency phne number. Obtain a User Accunt n the CMS Secure Prtal: This is an imprtant first step twards registratin fr the HHVBP Mdel prtal where HHAs will receive perfrmance reprts and enter data fr new measures. 5. D yu have clarificatin n the flu sht inf we are suppsed t get frm affiliated physicians? Des this mean we need t knw if every physician that signs ur plan f cares we have t get this inf n? There is n federal regulatry r plicy requirement t have the physician sign ff n infrmatin abut patient s influenza vaccine status. 6. When can we see the new required updates implemented in HEALTHCAREfirst s EMR sftware? HEALTHCAREfirst will be releasing new functinality fr firsthomecare in June 2016 that allws agencies t track the three new manual measures. Additinally, we are wrking n a reprt that will assist agencies in reprting the manual measures via the CMS HHVBP prtal. Lastly, we will be releasing a new Business Intelligence reprt that will allw yu t track yur prgress in real-time n submitted measures. Fr mre infrmatin abut this new functinality, please cntact HEALTHCAREfirst.

22 7. Please explain the CASPER Reprts and where can we find this in rder t cmpare Hme Health reprts? Infrmatin abut hme health Outcme Based Quality Imprvement (OBQI) and CASPAR reprting can be fund here: Assessment-Instruments/HmeHealthQualityInits/HHQIOASISOBQI.html. The OBQI reprts represent an aggregatin f OASIS-C patient status data cllected at the beginning and the end f an episde f care. Since HHAs nly submit OASIS-C data n Medicare and Medicaid patients, thse are the nly patients included in the reprts. The CASPER User Manual prvides infrmatin n hw t btain OBQI Reprts frm the CASPER system. It describes hw t request a reprt, hw t view a reprt nline, and hw t print r save a reprt. This manual can be fund n each HHA's OASIS State Welcme Page. 8. Can yu prvide infrmatin n the IMPACT Act? In CMS s Open Dr Frum fr hme care prviders n May 4, 2016, they stated that the IMPACT Act f 2014 requires CMS t implement standardized unifrm data elements t be nested within the assessment instruments fr fur pst-acute prviders hme health agencies, skilled nursing facilities, inpatient rehab facilities, and lng-term care hspitals. Accrding t CMS, ne f the next changes fr HHAs due t the IMPACT Act is the additin f three items t OASIS-C2 M1028 Active Diagnses, M1060 Height and Weight, and GG0170C. The new OASIS-C2 will take effect next January. Expect mre IMPACT Act-related changes in the future, experts warn. The prpsed calendar fr implementing measures can be fund at: Acute-Care-Quality-Initiatives/IMPACT-Act-f-2014/Stakehlder-Engagement- Opprtunities-and-Calendars.html. Hspice prvisins f the IMPACT Act include: Medicare-certified hspice prgrams will be required t underg a standard survey at least nce every 3three years thrugh fiscal Surveys must be cnducted by state r lcal survey agencies r an apprved accreditatin agency.

23 The Department f Health and Human Services (HHS) will cnduct eligibility recertificatin reviews f hspice prgrams that prvide care t individuals if the number f cases in which care is prvided fr mre than 180 days exceeds a percentage threshld f all care cases. The percentage threshld wuld be set by the department. Hspice prviders culd be subject t denial f payment rules if they aren t recertified. Hspice reimbursement and the hspice aggregate cap wuld align t a cmmn inflatinary index.