The was designed by the Centers for Medicare and Medicaid Services (CMS) to incentivize the delivery of high-quality, cost-effective home healthcare. Under the HHVBP Model, CMS evaluates home healthcare organizations鈥� performance on a set of specific quality measures and allocates reimbursement based on each organization鈥檚 scoring, relative to their peers鈥� scoring, incentivizing the quality rather than the quantity of care.
In an education session at the 2023 小猪视频 Growth, Innovation and Leadership Experience (小猪视频), Lisa McClammy, BSN, RN, COS-C, HCS-D, HCS-O, Senior Clinical Education Consultant at MAC Legacy, and Mike Carr, PT, COS-C, Senior Product Manager at 小猪视频, broke down the three categories used to calculate VBP scoring and provided actionable strategies to optimize VBP performance and sustain lasting financial health.
The Value-Based Purchasing Triathlon
The VBP scoring measures fall into three overarching categories, which can be conceptualized as a triathlon, where scoring for each distinct part is combined to generate one final score:
Monitoring these measures is essential to optimizing VBP performance and protecting and increasing reimbursement.
Winning Strategies for VBP
Carr and McClammy outlined the following strategies for VBP success:
Data Analysis and Performance Improvement
The first step to improving VBP performance is identifying where the organization stands currently on each performance measure.
鈥淵ou鈥檝e got to know what your data is,鈥� McClammy said. 鈥淭o me, the low-hanging fruit are the first things.鈥� She encouraged organizations to review their data and identify areas that can be immediately targeted for improvement.
Both Carr and McClammy emphasized the importance of access to real-time data, discouraging organizations from relying exclusively on Care Compare where publicly reported data is delayed. 鈥淵ou need something in your EMR or an interface with a vendor that supplies that real-time [data],鈥� Carr said. Access to real-time data is critical for continuous data monitoring and timely improvement targeting.
Areas that require improvement can be targeted through a performance improvement (PI) project. 鈥淚f you鈥檙e identifying a problem or a trend and you can fix it through a PI project, make it fun,鈥� McClammy said. 鈥淕et everybody鈥檚 input. Everybody probably has input on how they can improve a score. Find out what that is.鈥�
OASIS Accuracy
鈥淸OASIS accuracy] is one of the biggest areas [where] you can make improvement without having to spend a lot of resources,鈥� McClammy said. 鈥淵our clinicians want to do the right thing. They want to answer those questions correctly.鈥�
She encouraged organizations to train and retrain clinicians on the following critical elements:
- Score before you fix: 鈥淢ake sure [clinicians are] scoring [patients] how they found them,鈥� McClammy said. 鈥淭hen when you come back and reassess, you鈥檝e made improvements鈥ake sure they understand that, because sometimes they鈥檒l fix [a problem] while they鈥檙e there and then they鈥檒l score based on the fix. You don鈥檛 want to do that.鈥�
- Think of the OASIS as a walk, not an interview: 鈥淚f you don鈥檛 walk your patient to every one of [their] rooms, you haven鈥檛 done a full assessment,鈥� McClammy said. 鈥淵ou can鈥檛 know how they get in and out of the bed if you don鈥檛 go to the bed.鈥�
- Collaborate: Collaborate with every staff member who has contact with the patient, including therapists and aides. 鈥淸The] OASIS doesn鈥檛 need to be done in a day,鈥� Carr said. 鈥淲e have that five-day window. If you鈥檙e not using it, you鈥檙e missing an opportunity to share minds鈥to] get the right answer. The right answer isn鈥檛 always the nurse answer being two or the therapist answer being three. It needs to be discussed to see which [is] the more correct answer.”
Prevent Hospitalizations
Hospitalizations comprise 26% of an organization鈥檚 total VBP score. 鈥淥f all the individual items, that鈥檚 the one to focus on the most,鈥� Carr said. 鈥淚f you don鈥檛 do anything else well, focus on keeping your patients out of the hospital because that鈥檚 your biggest margin for improvement.鈥�
Carr and McClammy identified falls and medication issues as the two most common reasons for hospitalizations. To minimize hospitalizations, organizations must focus on preventing falls and managing medications and diseases appropriately.
鈥淢ake sure that those interventions are patient-specific,鈥� McClammy said. 鈥淭hat patient may have stairs that they have to access. They may have a step up or down to get into their living room鈥o make sure that鈥our interventions and goals based on your fall prevention program are specific to that patient.鈥�
Other ways to prevent hospitalizations include maintaining an interdisciplinary team approach, scheduling telehealth visits between in-person visits, front-loading visits and staggering disciplines.
Patient Engagement
The third broad category included in VBP scoring is results. Implement the following best practices to improve HHCAHPS Survey performance:
- Provide all staff with the HHCAHPS Survey questions.
- Inform patients during admission that they may receive a survey.
- Use key phrases (scripting) when interacting with patients.
- Track all patient calls and follow until resolved.
- Investigate every complaint and incident.
For additional information on how to improve HHCAHPS Survey scores, read this 小猪视频 blog.
鈥淭he nice opportunity about value-based purchasing is there鈥檒l be agencies that succeed and do very well,鈥� Carr said. 鈥淭he potential is there鈥o have an increased revenue鈥o whether you鈥檙e a great elite marathoner or whether you鈥檙e just getting better than where you were, there鈥檚 still opportunity for success.鈥�
With more than 250 attendees, more than 40 sponsors and countless connections made, 小猪视频 2023 was a massive success for everyone. and register now for 小猪视频 2024, April 21-24 in Dallas.