Value-Based Purchasing Model Revises Home Health Payments
By - In an ongoing effort to advance the quality of economically profitable healthcare, the Centers for Medicare & Medicaid Services (CMS) looks again to the promotion of care quality. CMS’s new proposal launch, authorized through the Affordable Care Act (ACA), advocates for a revision of various payment policies and amendments to a stream of previously implemented requirements for those home health agencies falling under the Medicare umbrella.
Home health services, which include skilled nursing, home health aide, physical therapy, occupational therapy, speech-language pathology, medical social services, etc. involve payment via Medicare. A prospective payment system, says CMS, pays more for services administered to those beneficiaries with additional medical needs.
According to Andy Slavitt, Acting CMS Administrator, people desire the option to receive care from the comfort of their own homes and also from within their own communities. Says Slavitt, “CMS aims to make sure that care in the home is supported by a value-based care delivery model that is consistent with the rest of the system. The goal is that no matter where the care is delivered, it is supported by a payment system that rewards providers who deliver the highest quality outcomes.”
Says CMS, this proposed model, CMS-1625-P, included in the 2016 Home Health Prospective Payment System proposed rule, considers strengths of formerly implemented value-based purchasing programs. Such programs include the Hospital Value-Based Purchasing Program, the Home Health Pay-for-Performance and Nursing Home Value-Based Purchasing Demonstrations, CMS says.
“These changes reflect a broader strategy to create a health care system that supports better care, smarter spending, and healthier people,” says a press release from CMS. “Provisions in this and other proposed rules will help move the nation’s [health care] system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, attention to disease prevention, helping patients return home, managing and improving chronic diseases, and fostering a [more efficient] and coordinated health care system.”
The proposed model promotes an annual payment reduction or increase adjustment to current Medicare-certified home health agency payments according to measured levels of quality performance. Payment adjustments, says CMS, start at 5 percent and may eventually reach 8 percent.
Further summary, implications of the proposed rule
CMS says the proposed rule updates national, standardized 60-day episode payment rates, national per-visit rates, and the non-routine medical supply conversion factor. The propsed rule additionally provides information about CMS’s monitoring efforts about alleged impacts related to the rebasing adjustments. Aside from the aforementioned payment reductions, the proposed rule also updates case-mix weights via up-to-date data and an update on the Report to Congress, confirms CMS.
Indeed, such news from CMS comes in the wake of similar value-based payment initiatives where quality is directly linked to outcomes. The far-reaching effects of tangible financial revisions to home health agencies are tangible. CMS estimates 3.5 million beneficiaries receive home health services among 11,850 home health agencies. This costs Medicare almost $18 billion, CMS confirms.
As EHRIntelligence.com reported, 3.5 million Medicare beneficiaries accounted for a staggering $18 billion in services provided by 12,000 home health agencies within 2013.
Once again echoing Slavitt's words, it is hopeful those beneficiaries yearning for high quality, cost-effective, close-to-home care can openly receive this tri-fold advantage.
