Home Health - Industry Update and Quality Initiatives

Home Health - Industry Update and Quality Initiatives

Washington Update 2

Administrative Update for 2017 Washington in a Time of Transition Below are a list of top priority items for the Trump Administration: Focus on setting health care priorities, including repeal and replace of ACA Tom Price HHS Secretary confirmed and Seema Verma CMS Administrator in process and select political appointees Address regulatory activity that occurred at the end of the Obama Administration, such as bundled payment expansion, HH CoPs, and HH PCRD 3

Outlook for ACA Full ACA Repeal Unlikely, Partial Dismantling More Likely Trump Administration/Republican Congress likely to use reconciliation to repeal pieces of the ACA as a first priority in early 2017 Likely to Be Repealed Individual/ employer mandates Premium and cost-sharing subsidies Taxes (e.g., Cadillac tax) Will Be Debated Medicaid expansion CMMI IPAB Likely to Remain Intact Provider cuts (including productivity adjustments, HH rebase) Select market reforms (e.g., preexisting conditions, coverage to age 26) Most drug related provisions and MA payment changes ACA repeal and replace could be an iterative process done in several stage and effective date could be delayed 2-3 years, in order to stabilize the insurance market Replacement/Repair package will likely move under separate legislation 4

Other Legislative Priorities for 2017 Main Focus on ACA Repeal/Replace-Repair, But Other Legislative Proposals Also in Play A number of Medicare provisions will need to be extended this year including the home health rural add-on payment (expires Dec. 31, 2017) and therapy cap exceptions House Ways and Means Committee focused on PAC VBP legislation, which includes a VBP program for LTACs, IRFs, SNFs, and HHAs 2 to 8% or 1-2% of payments at risk depending on participation in alternate payment models such as CJR, BPCI, or HH VBP (percent at risk gradually phased in over time starting in 2020 and higher for providers not participating in alternate payment models) Success assessed based on performance on Medicare spending per beneficiary, discharge to community, and all condition risk adjusted potentially preventable hospital readmission measures Senate Finance Committee focused on legislation to improve chronic care coordination and management 5

Why Does Quality Matter? 6

Cost Concerns are Driving Huge Changes in Healthcare Delivery $1 trillion annually in the U.S. and could reach $6 trillion by 2050 - spends more for health care than any other developed country but does not have better outcomes 95% of all health care spending is for the chronically ill Failure to contain the containable undermines Potential of extending health care coverage (the ACA) Ability to cope with medical costs of aging population US Admin on Aging, DHHS

CMS.gov

CMS.gov

Reform in the Healthcare Industry Declines in margins and revenues due to payment reform Risk sharing, bundled payments, ACOs, seeing consolidation of health systems and providers as a result Focus on right care in the right setting at the right time Increased understanding of the value of PAC cost effective, patients desire to age in place Care coordination/communication/interoperability - technology Specialized clinical programs that cross between multiple service lines and settings of care Chronic disease management ( reducing avoidable hospitalizations) Wellness and prevention Shift from volume of services provided to patient outcomes achieved across the continuum Star Ratings for all Medicare.gov compare site providers Value Based Purchasing

Star Ratings 17

Why Star Ratings? The ACA calls for transparent, easily understood public reporting of quality of care information. Star ratings summarize performance using symbols (stars) to help consumers quickly and easily understand quality of care information. Star ratings spotlight differences in health care quality and identify areas for improvement Star ratings are updated quarterly to present the most current information available. Public reporting is a key driver for improving health care quality by supporting consumer choice and incentivizing provider quality improvement. 18

Quality of Patient Care Star Ratings 19

Quality of Patient Care Star Ratings Effective July 2015 on Home Health Compare and included 9 of the 24 current publicly reported process and outcome quality measures To receive a Star Rating, agencies must: Have at least 20 complete quality episodes discharged within the 12 month reporting period for data on a measure to be reported on HHC Have data for at least 5 of the 9 measures in the calculation Provider number active for at least 6 months 20

Quality Star Measures Nine process and outcome measures receive a star rating: Process Measures: Timely Initiation of Care Drug Education on all Medications Provided to Patient/Caregiver Influenza Immunization Received for Current Flu Season Outcome measures: Improvement in Ambulation Improvement in Bed Transferring Improvement in Bathing Improvement in Pain Interfering With Activity Improvement in Shortness of Breath Acute Care Hospitalization The overall Star Rating, which is publicly reported, averages the star ratings of the above 9 measures 21

Patient Survey Star Ratings 22

Survey Star Ratings Effective January 2016 on Home Health Compare and includes 4 of the 5 publically reported HHCAHPS Data come from the HHCAHPS Survey, a national, standardized, 34-item survey of patients experience of care received from their home health agency To receive a Star Rating, agencies must: Have at least 40 completed surveys over the fourquarter reporting period Be eligible for public reporting on Home Health Compare - serve at least 60 patients per year 23

Survey Star Measures Four HHCAHPS measures will receive a star rating: Composite Measures Care of Patients Communication Between Providers and Patients Specific Care Issues Global Item Overall Rating of Care Provided by the HHA The overall Survey Summary Star Rating, which is publically reported averages the above 4 HHCAHPS stars 24

Home Health Value Based Purchasing 25

HHVBP Overview Overview: The Home Health VBP program (HHVBP) ties quality to payment to incentivize quality improvement, encourage efficiency and improve beneficiaries experiences and outcomes. HHVBP applies a payment reduction or increase to Medicare HHA payments based on quality performance. Model Years: Baseline measurement year is 2015 Performance years from 2016 to 2020, beginning January 1, 2016 Payment adjustment begins in 2018 and goes through 2022 26

HHVBP Overview States included (all Medicare-certified HHA s): 20 Quality Measures: 3 Process Measures (OASIS) 9 Outcome Measures (OASIS and claims) 5 Patient Satisfaction Measures (HHCAHPS) 3 New Measures KAH: 89 provider numbers with total of 125 locations 27

VBP Payment Adjustment First payment adjustment begins 1/1/18 and will be applied to CY2018 based upon results from 2016 Year Payment Adjustments Based On Results From 2018 +/- 3% 2016 2019 +/- 5% 2017 2020 +/- 6% 2018 2021 +/- 7% 2019 2022 +/- 8% 2020 The overall economic impact of the HHVBP Model is an estimated $378 million in total savings from a reduction in unnecessary hospitalizations and SNF usage as a result of greater quality improvements in the home health industry over the life of the HHVBP Model (CY 2017 HH PPS Final Rule). 28

Outcome & CAHPS Measures (9) Outcome Measures 1. Improvement in Ambulation/Locomotion (OASIS) 2. Improvement in Bed Transferring (OASIS) 3. Improvement in Bathing (OASIS) 4. Improvement in Dyspnea (OASIS) 5. Discharge to Community (OASIS) 6. Acute Care Hospitalization: Unplanned Hospitalization During First 60 Days of HHA (Claims) 7. Emergency Department Use Without Hospitalization (Claims) 8. Improvement in Pain Interfering with Activity (OASIS) 9. Improvement in Management of Oral Medications (OASIS) (5) HHCAHPS 1.Care of Patients (CAHPS) 2. Communications Between Providers and Patients (CAHPS) 3. Specific Care Issues (CAHPS) 4. Overall Rating of Home Health Care (CAHPS) 5. Willingness to Recommend the Agency (CAHPS) 29

Process & New Measures (3) Process Measures 1. Influenza Immunization Received for Current Flu Season (OASIS) 2. Pneumococcal Polysaccharide Vaccine Ever Received (OASIS) 3. Drug Education on All Medication Provided to Patient/Caregiver During All Episodes of Care (OASIS) (3) New Measures 1. Process Influenza Vaccination Coverage for Home Health Care Personnel 2. Process Herpes Zoster Vaccination: Has the Patient Ever Received the Shingles Vaccination? 3. Process Advanced Care Plan 30

HHVBP Performance Reporting CMS releases quarterly and annual performance reports based on the most current data possible for a 12 month period show peer ranking, payment adjustment percentage and scoring methodology Scoring: Each measure scored 2 ways: Achievement: compared against state specific baseline targets Improvement: compared against the HHA performance compared to it s own baseline year Total Performance Score (TPS): Determined using the higher of the HHA s achievement OR improvement on each measure 31

HHVBP versus Star Ratings HHVBP Quality of Patient Care Stars Patient Survey Stars 3 Process Measures: Drug Education on all Medications Flu Vaccine Received for Current Flu Season Pneumococcal Polysaccharide Vaccine Ever Received 9 Outcome Measures: Improvement in Ambulation Improvement in Bed Transferring Improvement in Bathing Improvement in Pain Interfering With Activity Improvement in Dyspnea Improvement in Management of Oral Medications Discharged to Community Acute Care Hospitalization Emergency Department Use without Hospitalization 5 HHCAHPS Measures: Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care Willingness to Recommend the Agency 3 Process Measures: Timely Initiation of Care Drug Education on all Medications Flu Vaccine Received for Current Flu Season 6 Outcome measures: Improvement in Ambulation Improvement in Bed Transferring Improvement in Bathing Improvement in Pain Interfering With Activity Improvement in Dyspnea Acute Care Hospitalization 4 HHCAHPS Measures: Care of Patients Communications Between Providers and Patients Specific Care Issues Overall Rating of Home Health Care 32

Ranked Against Targets Score Range Average Score KAH Goals HHVBP versus Star Ratings HHVBP Your state and same-size cohort Achievement Points: Achievement Threshold Median score of HHAs in the state (CY 2015) Minimum to earn points Benchmark Average score of the top 10% of HHAs in the state (CY 2015) Gold standard / maximum points Improvement Points: Based on HHA performance compared to that HHAs baseline year targets (CY 2015) 0 100 Points Quality of Patient Care Stars All CMS HHAs in the nation Cut point targets move (up or down) quarterly with each CMS release HHAs are sorted based on score and equally placed into the star rankings Equal amount of HHAs in each ranking 0.5 5.0 Stars (half star increments) Patient Survey Stars All CMS HHAs in the nation Cut point targets move (up or down) quarterly with each CMS release HHAs are statistically clustered for similarities and then grouped into the star rankings No set amount of HHAs in each ranking 1 5 Stars (full star increments) TBD by CMS 3.24 Stars (Oct 16) 3.57 Stars (Oct 16) TBD; Will vary by state Attain a 3.0 star rating overall or higher Attain a 3 star rating overall or higher Keep in mind: Due to the difference in performance targets and state vs national scores, doing well in Stars does not mean doing well in VBP 33

KAH HHVBP Activities Developed EMR enhancements for vendor to implement Created state specific VBP trending tool for locations and overall quality measure improvement toolkit Developed ongoing division wide and state specific VBP educational series Live sessions and recorded for on demand viewing within our education platform Identified discrepancies/errors in the CMS HHVBP model implementation Resulted in correcting of demonstration wide report scores Centralized HHVBP functions to enhance oversight capabilities, trending, and scoring Partner with industry leading quality and performance data analytics and benchmarking vendor 34