The proposed expansion of the Home Health Value-Based Purchasing (HHVBP) Model has been a hot topic in the home health industry over the last few months.
But while a nationwide mandatory value-based reimbursement system would certainly cause disruption, some operators believe the best path forward is to simply stay focused on high-quality care in the present.
“I’m not having conversations within my organization about this. I just don’t have the time,” Dorothy Davis, the president and CEO of Visiting Nurse Health System (VNHS), said Thursday at the Home Health Care News FUTURE conference. “I’m having a lot of conversations with our health system partners about hospitalization rates. I’m [internally] having conversations about direct contracting, where we connect with payers, our palliative program.”
The Atlanta-based VNHS is a diversified home-based care provider. The nonprofit cares for about 6,500 patients across all of its service lines.
“To me, all those things are going to drive the value chain, but I’m not specifically creating a strategy for [HHVBP expansion],” said Davis, whose organization is located outside of the active nine-state demonstration program.
LHC Group Inc. (Nasdaq: LHCG) Chairman and CEO Keith Myers, also speaking at FUTURE, described HHVBP as “far from perfect.”
The Lafayette, Louisiana-based home health, hospice and personal care services provider has locations in seven of the nine HHVBP states. It has long assumed that the U.S. Centers for Medicare & Medicaid Services (CMS) would attempt moving forward with an expansion.
“We weren’t surprised by it,” Myers said. “With CMMI (the Center for Medicare & Medicaid Innovation), there were 54 programs that were initiated, and only three saved money. And HHVBP has the largest savings in the history of the initiative, so we expected them to go forward with it.”
LHC Group has performed well under the HHVBP demo, achieving about 2% in incentive payments in the demo states it does business in.
Similar to the point made by Davis, Myers said that his company’s strategy did not change much at all because of HHVBP, meaning an expansion wouldn’t force much rejiggering.
“We get asked a question quite often about [HHVBP], ‘What are you doing in those states differently?’” Myers said. “But we’re doing nothing different in those seven states that we’re not doing everywhere. We made the decision that quality was important. We probably were nudged to because of all the relationships we have with hospitals and health systems. They’re constantly pushing us to be better and do more. But if you approach value-based purchasing as just like a target market and don’t do the same thing in your system, I just think that isn’t a strategy we would do.”
Under the HHVBP expansion plan, home health agencies would get “scored” on several performance measures against peers across the U.S. for a maximum bonus — or penalty — of 5%.
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Claims-based measures would account for 35% of a home health agency’s overall score in most instances, with OASIS-based measures also accounting for 35%. HHCAHPS measures would account for 30% of an agency’s score.
Those percentages would be weighted differently if an agency is missing a measure category or specific measure.
“I think you have to have consistency in your model,” Myers said. “And you have to know what the specific anchor duties are that lead to improvement, and then just replicate those and be very disciplined. It’s kind of like any other business, really.”
Choose Home updates
As for other home health-related developments potentially coming down the pike, both Davis and Myers displayed optimism for the Choose Home Care Act of 2021, which was introduced in July.
Broadly, Choose Home would give nursing home-eligible Medicare beneficiaries more options for how and where they’re cared for following a hospital stay. If the legislation goes through, it would create a 30-day add-on to the Medicare home health benefit.
“I’m excited about the legislation, and I think it’s the right move for consumers,” Davis said. “One of the questions [I’ve been] asked is what I see as the next disruptor, and I think it’s consumers. Technology is always a disruptor. But consumers, with how smart they’re becoming, and how they understand the benefit, they’re disruptors. So to me, this is a consumer-driven direction.”
Myers likewise framed the legislation as not just a potential win for the home health industry, but also a victory for future patients.
“Choose Home could shift the dynamic, where home health spend is higher than SNF spend, and that would mean savings to Medicare,” Myers said. “But at the same time, in terms of consumers, there’s a billion dollars in copays being paid by those patients that would go away. So there’s savings for them, too.”
There is significant, bipartisan momentum in the Senate and House for the legislation, Myers said. Senators already on board are building co-sponsors, and he expects an official introduction in the House this fall.
As for where it could be placed, the reconciliation package is a possibility, but it’s more likely it would be passed after that package is pushed through.
“There are about 2 million patients a year that are admitted to SNF,” Myers said. “And we believe that roughly 35% of those could be cared for under Choose Home.”
That would mean close to 700,000 patients per year that would become part of the home health ecosystem that wouldn’t be otherwise.