Training critical as first annual report raises stakes of value-based adjustments

Prioritize OASIS training to try to find a last-minute boost in your Home Health Value-Based Purchasing (HHVBP) results for 2024.

 

In private Annual Performance Reports released Aug. 23, leaders are getting their first look at agency-specific payment adjustments for 2025 under HHVBP. Each provider will get a cut or bonus of up to 5% depending on outcomes on key measures.

 

Private quarterly progress updates have been available since last summer, but CMS noted during an online forum with providers in August that 70% of agencies had not viewed their most recent interim reports.

 

It’s too late to make process changes to impact the 2025payment adjustment — it’s based on 2023 results. But agencies looking ahead will focus on boosting their outcomes over the next four months, knowing the impact it could have in their race for a HHVBP bonus in 2026.

 

Finishing strong this year isn’t the only priority — new HHVBP measures and scoring in 2025 require work now to get staff prepared.

 

Avoiding hospitalizations has been a key priority under HHVBP, accounting for more than 26% of an agency’s score. But it’s a lagging measure and can take significant time to see improvement, says Mike Brents, managing director of technology consulting for SimiTree Healthcare Consulting in Hamden, Conn.

 

“Knowing that we only have four months remaining in 2024, shoring up OASIS scoring accuracy to realize improvements in the OASIS-based measures can often be the quickest metric to impact,” he says.

 

Improving the accuracy of your OASIS assessments will also impact risk-adjustment calculations that factor into PDGM payments and quality measures impacted by risk adjustment.

 

Two OASIS measures that agencies have struggled to improve even before HHVBP put a price tag on them are improvement in dyspnea and management of oral medications, says Michelle Horner, manager of clinical consulting and education at McBee in Wayne, Pa.

 

“The biggest issue is that clinicians do not understand how to properly assess the OASIS items, document their assessment and use their assessment to score the OASIS,” she says.

 

For example, improvement in dyspnea includes physical assessments and an interview of the patient and caregiver, Horner notes.

 

Clinicians must ask — using language that the patient understands — if they have had any shortness of breath in the last 24 hours.

 

With oral medications, it may be a case where the clinician isn’t aware of updated guidance. For example, in the last few years, CMS clarified that patients in an assisted living facility aren’t automatically scored a “3 — Unable to take medication unless administered by another person.”

 

“Many agencies feel they can’t improve ALF patients, but that is not the case,” Horner says.

 

The challenge for agencies is only going to get harder next year. Agencies must reach a threshold level to score any points for achievement on each measure.

 

For improvement in dyspnea, the threshold is 86.305%, and it’ll increase to 89.673% in 2025. For management of oral medications, the threshold is 80.990% and climbing to 85.175% in 2025.

 

“Those not meeting the threshold currently will have to work even harder in order to get achievement points and those currently meeting the threshold may not be in 2025,” Horner says.

 

Improvement in oral medications will also increase in importance in 2025, accounting for 9.00% of the total score, up from 5.83% currently.

 

Agencies that can’t meet achievement thresholds will want to focus on improving their agency score. Showing improvement compared to your agency-specific results will provide points even if you can’t meet achievement thresholds when compared to other agencies.

 

Better scores on dyspnea and oral medications will help this year and beyond. But agencies leaders also will want to educate themselves on what’s different in HHVBP scoring in 2025, Brents says.

 

“Understanding the new measures and how they are calculated is the first critical step toward improvement,” he says. “When things are measurable, they are manageable.”

 

The changes include:

 

Discharge Function. The single OASIS-based Discharge Function Score replaces the two separate scores for change in mobility and change in self-care.

 

The Discharge Function Score uses OASIS results on key GG items to measure a patient’s progress at discharge when compared to what would be expected.

 

This will be a challenge for many agencies because the M items that had been used to weigh self-care and mobility have been used in Star Ratings and public reporting for years, Brents says.

 

“The GG items have never been meaningfully impactful to quality measure before, much less future payment,” he says.

 

The more challenging items will be those that look similar to M items. For example, consider GG0170I (Walk 10 feet) and M1860 (Ambulation/locomotion). Where the GG item involves a specific distance, M1860 refers to broader ambulation abilities, Brents notes.

 

“This can lead to clinicians misapplying the broader M1860 criteria to GG0170I,” he says.

 

Hospitalization. The Home Health Within-Stay Potentially Preventable Hospitalization (PPH) measure replaces the scores for acute care hospitalization in the first 60 days and emergency department use in the first 60 days.

 

CMS argues the PPH measure will more accurately consider those hospitalizations and observation stays that agencies could have prevented.

 

It’s a new way of looking at hospitalizations, Brents says. “This new measure is relative to the entire home health stay, which could certainly be beyond that of 60 days for many patients.”

 

Discharge to Community. The claims-based discharge to community replaces the OASIS-based discharge to community. 

 

This may be the most overlooked change, Brents argues, because it now factors in hospitalizations after discharge from home health.

 

“To meet the new form of this measure, patients must have no unplanned hospitalizations and no death in the 31 days following home health discharge,” he says. “I believe this will surely impact home health length of stay and utilization of hospice across the industry — we may start to see an uptick in both.”