Home Health Value Based Purchasing Session 1: Overview Session 1: Overview HHVBP Sessions Future session topics: New Measures Form & KAHL Courses Total Performance Score & State Benchmarks / Achievement Thresholds Requesting Access to the Secure Portal Agency Specific Performance Reports 2 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 3 1
HHVBP Overview States included (all Medicare-certified HHA s): Quality Metrics: 6 Process Measures (OASIS) 10 Outcome Measures (OASIS and claims) 5 Patient Satisfaction Measures (HHCAHPS) 3 New Measures KAH: 89 provider numbers with total of 125 locations as of 4/15/16 4 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 Up to +/ 3% 2016 2019 Up to +/ 5% 2017 2020 Up to +/ 6 % 2018 2021 Up to +/ 7 % 2019 2022 Up to +/ 8 % 2020 5 HHVBP Measures Of the 24 measures: 14 are publically reported & easily accessible via SHP 3 are new measures - to be entered into CMS web portal Influenza Vaccination Coverage for HH care Personnel Has the Patient Ever Received the Shingles Vaccination Advanced Care Plan 2 are utilizations-claims based (60-day hosp & Emergent Care w/o hospitalization 5 are OASIS based-but not publically reported today Discharge to Community (OASIS) Prior Functioning ADL/IADL (OASIS) Care Management: Types and Sources of Assistance (OASIS) Influenza Vaccine Data Collection Period (OASIS) Reason Pneumococcal Vaccine Not Received (OASIS) 8 of 9 current Quality Star Measures are included in VBP Timely Initiation of Care not included in VBP 6 2
Outcome & CAHPS Measures (10) 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) 10. Prior Functioning ADL/IADL (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) 7 Process & New Measures (6) Process Measures 1. Care Management: Types and Sources of Assistance (OASIS) 2. Influenza Vaccine Data Collection Period (OASIS) 3. Influenza Immunization Received for Current Flu Season (OASIS) 4. Pneumococcal Polysaccharide Vaccine Ever Received (OASIS) 5. Reason Pneumococcal Vaccine Not Received (OASIS) 6. 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 8 HHVBP Performance Reporting CMS will release a series of quarterly and annual performance reports Enable HHAs to use the information for quality improvement throughout the year. Allow HHAs to become familiar with scoring methodologies before the annual final scores are determined. Quarterly report will include peer ranking. Annual report will detail payment adjustment percentage and explanation (only given to the specific HHA). Reports will be available through the HHVBP Secure Portal Reports will be based on the most current data possible and availability depends on the measure type: OASIS measures lag one quarter Claims/HHCAHPS measures lag two quarters HHAs will have 30 days after the report release date to request recalculation of their scores 9 3
Performance Report Schedule 10 VBP Performance Measures Scoring: HHA will be awarded points for all applicable measures (agency must have 20+ episodes for the measure) Measures with less than 20 episodes will be excluded and not count against the agency Weighting: Current quality measures (21 measures) will be weighted equally and will account for 90% of total performance score (TPS) New measures (3 measures) will be weighted equally and will account for 10% of TPS Total Performance Score (TPS): Determined using the higher of the HHA s achievement according to the target OR improvement on the measure in the performance period Performance Comparison: Performance will be compared to your cohort (other HHAs in the state based on size - smaller volume HHAs vs. larger volume HHAs) 11 New Measures Opportunity for CMS to study measures in home health that have been tested in other healthcare settings New measures do not use OASIS, Claims, or Survey data: Requires data collection and data entry by the HHA outside of existing systems. HHA s will submit the new measure data quarterly into the HHVBP Secure Portal. Data submitted will include what is true for that quarter only; it is not cumulative. New measures comprise 10% of the TPS Must submit data each quarter, even if zeros, to obtain credit and points 12 4
New Measures - Timeline 13 New Measures Data Elements Influenza Vaccination Coverage for Home Health Personnel: Percentage of home healthcare personnel who receive influenza immunization between October 1 of current year and March 31 of the following year 11 data points: general questions; contraindications; reasons for declining vaccine Required by employees, independent practitioners, and students/volunteers Herpes Zoster (Shingles) Vaccination: Percentage of beneficiaries receiving home health services during which patients were determined to have ever received the vaccine (Medicare & Medicare Advantage) 13-14 data points: general questions; those age 60 or older; contraindications; reasons for declination Requires data collection at SOC and discharge/transfer/death Advance Care Plan: Percentage of patients aged 65 years or older who have an advance care plan or documentation that an advance care plan was discussed (all payers) 13 data points: general questions; at SOC >age 65; documentation evident Requires data collection at start of care and discharge/transfer/death 14 KAH Data Collection Influenza Vaccination Coverage for Home Health Personnel: Working with HR to develop a tracking mechanism for new hires and active personnel so data can be entered into CMS web portal within 7 calendar days at the beginning of each quarter. Herpes Zoster (Shingles) Vaccination: A form will be released soon in KindredLink that will collect the required data elements at Start of Care and Discharge/Transfer/Death Reporting is in development to export this data Advance Care Plan: A form will be released soon in KindredLink that will collect the required data elements at Start of Care and Discharge/Transfer/Death Reporting is in development to export this data More information on the data collection process for the new measures will be included in future VBP webinars 15 5
HHVBP Secure Portal Purpose of the HHVBP Secure Portal Enter and approve final submission of New Measures data View quarterly and annual performance reports Initiate recalculation requests There are 5 HHVBP Secure Portal roles Primary POC (PPOC) Corporate POC (CPOC) Secondary Point of Contact Reviewer Data Entry EIDM User ID Instructions All HHVBP Secure Portal roles require an EIDM User ID 16 Portal Role Primary POC (PPOC) Corporate POC (CPOC) Secondary Point of Contact Reviewer Data Entry HHVBP Secure Portal Roles Role Description This role can view all reports and submit data, will grant HHVBP Secure Portal access to the Secondary POC, Reviewer, and Data Entry roles, as well as initiate recalculation requests. There has to be a PPOC for each CCN and there can only be 1 PPOC for each CCN. This role is approved by CMS. This role has the ability to view all information for the corporate CCNs, but does not have the ability to approve access or to enter data. This role is approved by CMS. This role acts as a proxy for the PPOC and is able to review and submit New Measure Data. Someone at the local level must have access as a Secondary POC This role acts as a quality check mechanism for the Data Entry Role and is able to review New Measure Data. This role can enter New Measure Data on behalf of the HHA but cannot submit it. KAH Guidelines for Access Centralized at the division level Clinical Practice & Quality Team Branch Directors/ Administrator/ Branch HHVBP Designee/DCO Not Currently Utilized Not Currently Utilized 17 HHVBP KAH Activities Monthly informational calls for locations in the 9 VBP states Staff education on low scoring measures in KAHL Review Quarterly Performance Reports (agency specific) Enter New Measure data into HHVBP secure portal quarterly Information related to VBP will be distributed via the KAH HH Value Based Purchasing email distribution list 18 6
More Information CMS Home Health Value Based Purchasing Site: https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model HHVBPquestions@cms.hh.gov Resources: EIDM User ID Creation Instructions CMS HHVBP Quality Measures List KAH Division HH Clinical Practice & Quality Team: Judy Fenton, VP Clinical Practice and Quality Judy.Fenton@Kindred.com Cyndi Shook, Director Quality and Performance Improvement Cynthia.Shook@Kindred.com Oneika Webb, Director Quality and Performance Improvement Oneika.Webb@Gentiva.com Amy O Brien, Clinical Project Manager Amy.Obrien@Gentiva.com Matt Janes, Director, Therapy Practice and Quality Matt.Janes@Gentiva.com 19 7