Showing posts tagged with: VBP

Value-Based Purchasing At A Glance

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Accountable Care Organizations, Clinical Documentation Improvement, The Affordable Care Act (ACO), Value-Based Purchasing

Value-Based Purchasing At A Glance

Successfully Navigating the Home Healthcare Industry to Value-Based Purchasing Through Clinical Documentation Improvement (CDI)

 
On April 29, 2011, the healthcare industry changed forever. It’s on that date that the Centers for Medicare and Medicaid Services (CMS) released its Hospital Value-Based Purchasing (VBP) Final Rule, required under the Patient Protection and Affordable Care Act (StuderGroup, 2016). What is Value-Based Purchasing? The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries. How does Hospital VBP Work? CMS rewards hospitals based on:
  • The quality of care provided to Medicare patients;
  • How closely best clinical practices are followed; and
  • How well hospitals enhance patients’ experiences of care during hospital stays.
Hospitals are no longer paid solely on the quantity of services they provide. The Affordable Care Act of 2010 established the Hospital VBP Program, which applies to payments beginning in Fiscal Year (FY) 2013 and affects payment for inpatient stays in more than 3,000 hospitals across the country (cms.gov, 2016). How to improve your Agencies quality?
  • You must build a solid foundation...
  • Great field clinicians are not necessity
How does Select Data improve your Agencies quality? Through Clinical Documentation Improvement (CDI). Clinical documentation is at the core of every patient encounter (Ahima, 2017). Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Select Data improves your clinical documentation and provides a clear picture of your patients health. Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Call Select Data at 1.800.332.0555 for more information. References Ahima (2017). Clinical Documentation Improvement: Overview. Retrieved from: http://www.ahima.org/topics/cdi CMS.gov (2016). Hospital Value-Based Purchasing. Department of Health and Humans Services: Centers for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf Studer Group (2016). VALUE-BASED PURCHASING AT A GLANCE:Fiscal Year 2016 and Your Organization. Studergroup.com. Retrieved from: https://www.studergroup.com/industry-impact/value-based-purchasing
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555. Click here to contact us.

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Home Health Value Based Purchasing Model: It’s One Year Old and Growing

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Clinical Practices, The Affordable Care Act (ACO), Value-Based Purchasing

Home Health Value Based Purchasing Model: It’s One Year Old and Growing

Successfully Navigating the Home Healthcare Industry to Value Based Purchasing

 
Last January, 2016, the CMS Innovation Center launched the Home Health Value Based Purchasing (HHVBPM) aka VBP Model in the following nine states:
  • Arizona
  • Florida
  • Iowa
  • Maryland
  • Massachusetts
  • Nebraska
  • North Carolina
  • Tennessee
  • Washington
This is part of a larger movement across the healthcare system in the US. CMS, as well as other payors want payment tied more closely to the quality of care delivered.  CMS wants to reward those Medicare certified agencies that perform well on select quality measures. The belief is that those agencies that perform well under VBP will have an increase in revenue and those agencies that cannot perform well with the identified quality measures will be penalized by shrinking margins. The maximum payment adjustments are planned as follows:
  • 3% upward or downward in 2018
  • 5% upward or downward in 2019
  • 6% upward or downward in 2020
  • 7% upward or downward in 2021and
  • 8% upward or downward in 2022
CMS expects to expand the VBP model to other states in the future. There were originally 24 quality measures proposed for review, however in June, 2016, CMS proposed dropping four of those measures.  Using data from OASIS, Medicare claims, HHCAHPS surveys, and other reported data, agencies will be evaluated quarterly receiving reports on their performance compared to their baseline in previous quarters as well as how their performance stands up against other agencies within their state. There are nine quality outcome measures used to determine payment awards:
  • Improvement in Ambulation
  • Improvement in Dyspnea
  • Improvement in Bed Transferring
  • Improvement in Bathing
  • Improvement in pain interfering with activity
  • Improvement in Oral Medication Management
  • Emergency department use without hospitalization
  • Acute Care Hospitalization
  • Discharge to the Community
There are three quality process measures used to determine payment awards:
  • Influenza immunization received
  • Pneumococcal vaccine received
  • Medication education
There are five consumer outcome measures used to determine payment awards
  • Care of patients
  • Specific Care issues
  • Communication between the patient and the care provider
  • Patient willingness to recommend the provider of care
  • Patient’s overall rating
There are three new additional measures used to determine payment awards:
  • Influenza vaccination for provider’s home health personnel
  • Herpes zoster vaccination for provider’s home health personnel
  • Advanced care planning
Using the above measures, agencies will receive an “achievement score” that compares an agency to peer agencies and an “improvement score” that compares the agency with their baseline year. For each process and outcome measure, those two scores will be calculated and the higher of the two scores will count toward the agency’s overall “Total Performance Score (TPS).”  The three new measures count toward 10% of the total score. What can your agency do to positively impact the agency’s score?
  • Your agency must become educated in the HHVBP model and the measures.
  • Industry experts believe CMS will implement this nationwide sooner than anticipated. Look at each item and hone in on 1-2 items at a time. Consider focusing on the process measures, as they are seen to be easier to affect change.
  • If you are a high performing agency, then more opportunity may exist with achievement scores.
  • If your agency has consistently struggled, focus on the improvement scores.
  • Conduct a gap analysis as to clinician understanding of each OASIS and HHCAHP item.
  • Provide OASIS education specifics. Hone in on SOC opportunities for assessment evaluation.
  • Provide clinician education regarding HHCAHPS and the questions that will impact your agency.
  • Be certain your agency’s software has the capability to assist in analysis of clinical documentation analytics and reporting regarding OASIS and Claims data.
Don’t wait, if you are an agency in one of the 41 states not yet officially affected. VBP is here to stay. Payors other than CMS are also looking at patient outcomes by diagnoses and using that factor as a guide as to whether or not they wish to contract with a provider. For a small Medicare certified agency, a 3% reduction in payment will be painful and a 5% reduction could be unsustainable. You need to be active in VBP education NOW! You may need to designate a position only for data analytics. You need to have strong partners whether in your EMR, your coding and document review, or in analyzing and providing the best plan of care for the patient in order to meet the VBP outcome level goals. Consider Select Data as a partner in achieving the best patient plan of care for the diagnoses to be coded and the goals needed to achieve those high quality goals and succeed with the CMS quality measures. Call Select Data at 1.800.332.0555 for more information.
Select Data is committed to a strong compliance program that includes educating all personnel on mitigating HIPAA breaches. For more information about Select Data and their commitment to quality in Home Health and Hospice, call 1.800. 332.0555. Click here to contact us.

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