Situation Report | June 14, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) has released the fourth annual report on the Home Health Value Based Purchasing (HHVBP) Demonstration, which includes data from calendar year (CY) 2019. This data will impact payment adjustments for participating home health agencies (HHAs) for CY 2021. Certified Home Health Agencies (CHHAs) in New York are currently not part of CMS’s HHVBP demonstration.
Most significantly, the report found aggregate savings of $604.8 million in overall Medicare spending for fee-for-service (FFS) beneficiaries receiving home health services during 2016-2019. The savings are largely driven by reduced spending for inpatient and skilled nursing facility (SNF) services. These savings, due to HHVBP, were partly offset by an estimated 6.1 percent increase in Medicare spending for outpatient emergency department (ED) visits and observation stays through 2019, which translates to a cumulative (2016-2019) increase in spending of $65.3 million for these services.
Despite the larger total point score (TPS) weights assigned to the unplanned hospitalization measure (from 6.25 percent in 2018 to 26.25 percent in 2019), the change in TPS weight did not result in greater improvements in performance on this measure in 2019 beyond the gains that had already occurred under HHVBP.
The analysis found that CHHAs reduced unplanned hospitalizations under the model through such mechanisms as an increased use of frontloading skilled nursing and therapy visits during home health episodes that follow an inpatient stay.
The analyses showed no substantial unintended impacts of HHVBP during the initial four years of implementation. There was no evidence of an overall HHVBP effect on Medicare spending for home health care, home health utilization, or access to home health care. However, the researchers did find differential impacts of HHVBP based on Medicaid coverage, where there was not a favorable impact of the model on unplanned hospitalizations and improvements in functional outcomes among Medicaid patients.
Although HHVBP has not led to changes in the overall use of home health services, there was evidence of modestly lower growth in severity among patients receiving care from HHVBP agencies relative to agencies in non-HHVBP states. This also is an area that requires further evaluation.
Additionally, CMS was unable to provide any data to understand how the Patient Driven Groupings Model (PDGM) for CHHAs will impact the HHVBP model.