VALUE-BASED PURCHASING

VALUE-BASED PURCHASING Presented By: Melinda A. Gaboury, CEO Healthcare Provider Solutions, Inc. targetedprobeandeducate.com Value Based Purchasing (VBP) Pilot 3 8% payment at risk for incentive payments Not a withholding of funds like some have believed.set aside or allocated for distribution Phase in to 8% Payment Adjustment Timeline 5 performance years beginning in 2016 2016 Performance = 2018 payment adjustment (3%) 2017 Performance = 2019 payment adjustment (5%) 2018 Performance = 2020 payment adjustment (6%) 2019 Performance = 2021 payment adjustment (7%) 2020 Performance = 2022 payment adjustment (8%) Updates to the rule can be issued at any time beginning with 2019! One possibility is updating payments every 6 months versus annually! 1

Outcome & Process Measures VBP Source Home Health Compare Timely Initiation of Care Multiple Improvement In Ambulation/Locomotion M1860 Improvement In Transferring M1850 Improvement In Bathing M1830 Improvement In Management of Oral Meds M2020 Improvement In Pain M1242 Improvement In Dyspnea M1400 60-Day Acute Care Hospitalization Rate Claims 60-Day Emergency Department Use Claims Discharged to Community M2420 Prior ADL/IADL Functioning M1900 Influenza Immunization Received M1046 Pneumococcal Vaccine Ever Received M1051 Drug Education for all Meds (not VBP eff 1/1/18) M2016 Reason Pneumococcal Vaccine Not Received Influenza Vaccine Data Collection Period Types and Sources of Assistance M1056 M1041 M2102 Star Rating Effect of Data Across Programs HHCAHPS Measures VBP Source Home Health Compare Communication HHCAHPS Star Rating Care of Patients HHCAHPS Specific Care Issues HHCAHPS Overall Rating HHCAHPS Would Definitely Recommend HHCAHPS 2

Value Based Purchasing (VBP) Pilot Achievement Threshold calculated as the median of all HHAs (in the state) performance on the specified quality measure during the baseline Benchmark calculated as the mean of the top 10% of all HHAs (in the state) performance on the specified quality measure during the baseline period 2015 will consistently be used as the baseline period in order to evaluate the degree of change that may occur over the multiple years of the model. Value Based Purchasing (VBP) Pilot Achievement Scoring HHA with performance =/> than benchmark receives 10 points HHA with performance =/> achievement threshold receives 1 9 points based on formula: HHA with performance < achievement threshold receives 0 points All rounding will now be to 3 rd decimal point, example: 4.5555 will be 4.556 3

Value Based Purchasing (VBP) Pilot Improvement Scoring HHA with performance =/> than benchmark receives 10 points HHA with performance > its baseline period receives 1 9 points based on formula: HHA with performance =/< baseline period score receives 0 points Value Based Purchasing (VBP) Pilot Total Performance Score (TPS): higher of achievement or performance score in each measure All Outcome and Process measures have equal weight and account for 90% of TPS Points only for applicable measures (20 episodes per year) 0 to 10 points on each Outcome and Process measure Three New Measures reported accounts for 10% if reported get the full 10 points (10 or 0 points on New Measures) 4

VALUE BASED PURCHASING REPORTS Value Based Purchasing Review Quarterly Quality Reports July 2016 FIRST report (for 1 st Quarter 2016) 15 days to request recalculation of scores CMS will not be required to provide backup for the calculation agencies will need to monitor their own data Opportunity to review Total Performance Score (TPS) and payment adjustment calculations August 1, 2018 FIRST notification 15 days to request recalculation Final report no later than November 1, 2018 to reflect payment adjustments for 2019 5

VALUE BASED PURCHASING REPORTS Finalized that if it is determined that the calculation was correct and deny the HHA request for recalculation of the Annual TPS and Payment Adjustment Report, or if the HHA disagrees with the results of a CMS recalculation of such report, the HHA may submit a reconsideration request for the Annual TPS and Payment Adjustment Report. The reconsideration request and supporting documentation would be required to be submitted via the form on the HHVBP Secure Portal within 15 calendar days of CMS' notification to the HHA contact of the outcome of the recalculation request for the Annual TPS and Payment Adjustment Report. Finalized that a HHA may request reconsideration of the outcome of a recalculation request for its Annual TPS and Payment Adjustment Report only. Understanding IPR Reports Achievement Points Improvement Points Care Points (comparing Achievement to Improvement) New Measures Total Performance Scores 6

Measures Achievement Points HHA Performanc e Score Data Period 12 Month Ending Achievemen t Threshold Benchmar k Current Achieveme nt Points Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all 2016-09-30 99.573 96.083 99.728 9.117 Episodes of Care Influenza Immunization Received for Current Flu 2016-09-30 78.673 74.831 88.236 3.079 Season Pneumococcal Polysaccharide Vaccine Ever 85.248 79.372 93.389 4.273 Received 2016-09-30 Improvement in Bathing 2016-09-30 72.574 65.593 78.883 5.228 Improvement in Bed Transferring 2016-09-30 74.646 61.3 74.551 10 Improvement in Ambulation- Locomotion 2016-09-30 71.7 64.699 75.276 6.457 Improvement in Management of Oral Medications 2016-09-30 54.381 51.487 64.208 2.547 Improvement in Dyspnea 2016-09-30 75.425 70.714 85.934 3.286 Improvement in Pain Interfering with Activity 2016-09-30 73.776 67.231 81.53 4.62 Discharged to Community 2016-09-30 72.988 70.679 78.229 3.252 Claims-Based Measures Emergency Department Use Without Hospitalization 2016-06-30 15.046 14.395 9.272 0 Acute Care Hospitalizations 2016-06-30 15.359 16 11.447 1.767 HHCAHPS Measures Care of Patients 2016-06-30 92.33 90.405 94 5.319 Communications Between Providers and Patients 2016-06-30 91.982 88.032 92.386 8.665 Specific Care Issues 2016-06-30 88.739 84.672 90.836 6.438 Overall Rating of Home Health Care 2016-06-30 87.759 87.153 93.431 1.369 Willingness to Recommend the Agency 2016-06-30 84.701 82.703 90.235 2.887 Measures Improvement Points HHA Data Period 12 Performanc Month Ending e Score Baseline Period Score Benchmar k Current Improvement Points Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all 2016-09-30 99.573 98.821 99.728 7.791 Episodes of Care Influenza Immunization Received for Current Flu 2016-09-30 78.673 80.738 88.236 0 Season Pneumococcal Polysaccharide Vaccine Ever 2016-09-30 85.248 81.516 93.389 2.643 Received Improvement in Bathing 2016-09-30 72.574 62.101 78.883 5.741 Improvement in Bed Transferring 2016-09-30 74.646 59.166 74.551 9.562 Improvement in Ambulation- Locomotion 2016-09-30 71.7 63.08 75.276 6.568 Improvement in Management of Oral 2016-09-30 54.381 47.697 64.208 3.548 Medications Improvement in Dyspnea 2016-09-30 75.425 58.606 85.934 5.654 Improvement in Pain Interfering with Activity 2016-09-30 73.776 60.996 81.53 5.724 Discharged to Community 2016-09-30 72.988 72.204 78.229 0.801 Claims-Based Measures Emergency Department Use Without Hospitalization 2016-06-30 15.046 16.994 9.272 2.023 Acute Care Hospitalizations 2016-06-30 15.359 15.242 11.447 0 HHCAHPS Measures Care of Patients 2016-06-30 92.33 90.695 94 4.447 Communications Between Providers and Patients 2016-06-30 91.982 89.986 92.386 7.817 Specific Care Issues 2016-06-30 88.739 89.585 90.836 0 Overall Rating of Home Health Care 2016-06-30 87.759 85.329 93.431 2.499 Willingness to Recommend the Agency 2016-06-30 84.701 82.589 90.235 2.262 7

*Source: 2017 Home Health Final Rule Make sure to reference your actual VBP Reports from the portal as illustrated on the two previous slides. 15 Measures Oasis-Based Measures Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care Care Points Sufficient Data for Measure Inclusion (0= No; 1=Yes) Current Achievement Points Current Improvement Points Current Care Points 1 9.117 7.791 9.117 Influenza Immunization Received for 1 3.079 0 3.079 Current Flu Season Pneumococcal Polysaccharide Vaccine 1 4.273 2.643 4.273 Ever Received Improvement in Bathing 1 5.228 5.741 5.741 Improvement in Bed Transferring 1 10 9.562 10 Improvement in Ambulation- Locomotion 1 6.457 6.568 6.568 Improvement in Management of Oral 1 2.547 3.548 3.548 Medications Improvement in Dyspnea 1 3.286 5.654 5.654 Improvement in Pain Interfering with Activity 1 4.62 5.724 5.724 Discharged to Community 1 3.252 0.801 3.252 Claims-Based Measures Emergency Department Use Without Hospitalization 1 0 2.023 2.023 Acute Care Hospitalizations 1 1.767 0 1.767 HHCAHPS Measures Care of Patients 1 5.319 4.447 5.319 Communications Between Providers and Patients 1 8.665 7.817 8.665 Specific Care Issues 1 6.438 0 6.438 Overall Rating of Home Health Care 1 1.369 2.499 2.499 Willingness to Recommend the Agency 1 2.887 2.262 2.887 Total Available Measures For TPS Calculation 17 86.554 8

Calculation of Applicable Measures Total Performance Score Classifications Applicable Measures (AM) Raw Total Points (RTP) Total Applicable Measure Points (RTP/AM)*10 Weight Applicable Measures Final Weighted Score (AMFWS) Points 17 86.554 50.914 90% 45.823 Cumulative Applicable Measures Score 45.823 Calculation of New Measures Classifications Available Points (AP) Raw New Measure Points (RNMP) Total New Measure Points (RNMP/AP)*100 Weight New Measures Final Weighted Score (NMFWS) Points 30 30 100 10% 10 Cumulative New Measure Score 10 Percentile Ranking within Cohort 75 Total Performance Score Summary Classifications Final Weighted Score (FWS) Percentile Ranking within Cohort Applicable Measure Final Weighted Score (AMFWS) 45.823 New Measure Final Weighted Score (NMFWS) 10 Total Performance Score (TPS) 55.823 75 Percentile TPS rankings are presented in wide ranges 9

Overall projection table from 2017 payment rule Consider Wide ranges in the IPR percentile rankings Revenue weighting can impact results in LEF calculation Some states of small and large cohorts to consider 19 State specific projection tables from 2017 payment rule 20 10

11

Finalized Changes 2018 Home Health Care Consumer Assessment of Healthcare Providers and System (HHCAHPS) Surveys proposing to change the required number of completed surveys returned in order to calculate a performance score (currently 20 and proposed to be 40). If finalized, this proposed change will be applied to the FIRST performance year (2016) before it is finalized in the Fall/Winter 2017. Proposing to remove the OASIS-based measure Drug Education on All Medications Provided to Patient/Caregiver during All Episodes of Care. If finalized this measure will be removed beginning with performance year 3 (2018). 23 Finalized Changes 2018 Quality Measures for future consideration of proposal.not officially being proposed in this rule Total Change in ADL/IADL Performance by HHA Patients this measure would report the average, normalized, total improved functioning across the 11 ADL/IADL item on the current OASIS-C2. The patient s discharge score would be subtracted from the Start of Care (SOC)/Resumption of Care (ROC) score and then divided by the maximum improvement value based the number of response options for that item. All eligible episodes would be considered including episodes where the patient WAS INDEPENDENT at the SOC/ROC. 24 12

Finalized Changes 2018 Composite Functional Decline Measure this measure would report the percentage of episodes where there was a decline on one or more of the 8 ADL items used in the measure. Behavioral Health Measures HHA Correctly Identifies Patient s Need for Mental or Behavioral Health Supervision using multiple factors including items from Neuro/Emotional/Behavioral Status OASIS-C2 items. Caregiver Can/Does Provide for Patient s Mental or Behavioral Health Supervision Need - using multiple factors including items from Neuro/Emotional/Behavioral Status OASIS-C2 items. 25 HH CAHPS - Communication With Patients It is not acceptable, however, for an HHA to do the following: Mail or e-mail information to patients in advance alerting them about the survey, other than the information provided to all patients; Provide a copy of the HHCAHPS Survey questionnaire or cover letters to the patients; Include words or phrases verbatim from the HHCAHPS Survey in its marketing or promotional materials (CMS is encouraging HHAs not to use text from HHCAHPS questions in their marketing and promotional materials); Attempt to influence their patients answers to the HHCAHPS Survey questions; 13

HH CAHPS - Communication With Patients Tell the patients that the agency hopes or expects that its patients will give it the best or highest rating or to respond in a certain way to the survey questions; Offer incentives of any kind to the patients for participating (or not) in the survey; Help the patient answer the survey questions, even if the patient asks for the home care provider s help; Ask patients why they gave a certain response or rating to any of the HHCAHPS Survey questions; and Include any messages or materials promoting the HHA or the services it provides in survey materials, including mail survey cover letters and questionnaires and telephone interview scripts. HH CAHPS Texas Nation 28 14

HH CAHPS Texas Nation 29 Lowest Scoring Categories Seemed informed and up to date? Ensure that POC is always available and present for each visit Review chart for updates before entering the home Keep you informed about arrival time? Call /confirm visits the night before or morning of Provide a range for the visit time. 30 15

Lowest Scoring Categories Listen carefully to you? Repeat to patient what they have said to you. Make eye contact when patient speaks Provide solutions/answers to problems and concerns Specific care issues: Use the language in these questions in the day to day care of the patient: purpose, over-thecounter, safely, etc. 31 HHCAHPS - How Do We Improve? Share your results Engage your staff in improvement all staff! Be deliberate and focused Be specific Develop standards, scripts and behaviors Don t forget identifying processes that create problems & correct them Call patient s family after admission and periodically Hold managers and staff accountable 32 16

Speaker Contact Info Melinda A. Gaboury Chief Executive Officer Healthcare Provider Solutions, Inc. 810 Royal Parkway, Suite 200 Nashville, TN 37214 615-399-7499 Phone 615-399-7790 Fax info@healthcareprovidersolutions.com www.targetedprobeandeducate.com 17