Value-Based Purchasing is on the Horizon for Home Health Agencies

April 1, 2021
April 1, 2021
By Karen F. Sorensen, Associate Vice President, National Initiatives, HealthStream

The Centers for Medicare & Medicaid Services (CMS) has published its proposal to implement a Home Health Value-based Purchasing model for Medicare-certified home health agencies (HHAs) in selected states starting in 2016. The model will test whether incentives for better care can improve outcomes in the delivery of home health services. If approved, all Medicare-certified HHAs in the following states will be required to participate in the model: 

  • Arizona
  • Iowa
  • Florida
  • Massachusetts
  • Maryland
  • Nebraska
  • North Carolina
  • Tennessee
  • Washington 

When announcing the proposed model, Acting CMS Administrator Andy Slavitt said, “People want to be taken care of in their homes and communities whenever possible, and 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.”  

Similar to the Hospital VBP program, the distribution of payments would be based on quality performance, as measured by both achievement and improvement across multiple quality measures, including the Home Health CAHPS Survey. Some HHAs would receive higher payments than standard fee-for-service payments and some HHAs would receive lower payments, similar to the Hospital VBP program. 

CMS proposes to implement this model over 7 years beginning on January 1, 2016, and ending on December 31, 2022. Payment adjustments will be phased in incrementally with a maximum payment adjustment of 5% (upward or downward) in 2018 and 2019, a maximum payment adjustment of 6% (upward or downward) in 2020, and a maximum payment adjustment of 8% (upward or downward) in 2021 and 2022.  

The specific goals of the proposed model are to: 

1. Incentivize HHAs to provide better quality care with greater efficiency

2. Study new potential quality and efficiency measures for appropriateness in the home health setting

3. Enhance current public reporting processes.  

The HHVBP model would not alter the HHCAHPS current scoring methodology or the participation requirements in any way. 

So, what do you think? Will a HHVBP program achieve its stated objectives?       

CMS is accepting comments on the proposal until September 4, 2015. For more information, please visit:

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