WASHINGTON, D.C. (January 29, 2020)—The Centers for Medicare and Medicaid Innovations (CMMI) has issued the second annual report on the Home Health Value Based Purchasing (HHVBP) program. The report reflects the performance of participating agencies and non-participating agencies (as a comparison group) for calendar years 2016 and 2017.
The total points scores (TPS) for agencies in HHVBP states were higher overall relative to the TPS scores calculated for agencies in the non-Model states in both 2016 and 2017. For both of the first two years of the Model, these differences in TPS largely reflect higher measure scores for the seven OASIS-based outcome measures.
Through the first two performance years of the HHVBP Model, there was evidence of reductions in Medicare spending for Fee For Service (FFS) beneficiaries receiving home health care as well as modest improvements in many measures of quality of care. The observed improvements in quality measures include a pattern of declines in the utilization of unplanned hospitalizations and SNF use that may have contributed to the observed reductions in Medicare spending for FFS beneficiaries receiving home health services. There was a 3.9% decline in average Medicare expenditures for unplanned hospitalizations among FFS beneficiaries receiving home health services in HHVBP states relative to average expenditures during 2013—2015, translating to an average annual reduction of $88 million during the first two years of the HHVBP Model. However, the report also noted an increase in ED use, which suggests one potential offset to these decreases in expenditures.
Changes in agency operations show that after the HHVBP Model was underway, nearly all agencies interviewed were implementing, or making incremental changes to, staff training and education activities to improve performance on the HHVBP-specific measures.
There was no evidence of an HHVBP impact on patient experience measures through the first two performance years of the Model. Performance scores for the five patient experience measures derived from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey remained relatively stable over time in both HHVBP states and non-HHVBP states.
There was no evidence of widespread HHVBP effects on utilization of home health services, or on the characteristics of patients receiving these services. Additionally, there was no impact on access to home health services based on referral sources and no signs of a major shift in referral patterns or patient access to home health services as a result of HHVBP. Further, agencies in HHVBP states did not report making changes in their relationship to referral sources.