Value based purchasing has spread to the home health market.  Is your agency affected? 

CMS has decided to launch a pilot program to approach a value based purchasing program for home health agencies. It has used the lessons it has learned from other value based purchasing programs in an effort to align payment with quality. CMS is hoping that this will incentivize providers to focus on patient care as well as improve the patient experience.

Does HHVBP affect your agency?

Currently, the HHVBP pilot program includes only 9 states.  Based on data collected, CMS created 9 regions across the country, each with its own unique home health care environment and selected a state from each of the 9 regions to be a part of the pilot program. The states that were selected to participate in the pilot program which begins on January 1, 2016 are:

North Carolina

These states will begin reporting HHVBP data in January 2016. So if your not in these states, it isn’t affecting you now, but it might a good idea to have an understanding of the program in general so that you can align your home health accordingly and be aware of the changes that might be coming, because, as we have all learned from prior experience, pilot programs tend to stop being pilot programs and roll out nation-wide at some point.

What are the measures that will be reported for HHVBP

The performance measures will largely come from data that Home Health agencies are already submitting to CMS (Oasis, Claims, and HHCAHPS) so agencies really won’t have to do anything differently to report these measures. There are three new measures that will require the agency to submit data to a newly introduced CMS portal.

New measures

Influenza Vaccination Coverage for Home Health Care Personnel
Herpes Zoster (Shingles) Vaccination
Advance Care Plan
The submission of the new measures will begin on October 7, 2016. The data submitted will be from the coverage period of July to September of 2016.

What should my agency do.

Well, if your agency is in one of the 9 states you should definitely create an account for the new CMS portal. No home health software vendor or intermediary can create this portal account for you. This is something you will have to do yourself. Also, make sure that your current software is able to submit HHCAPS, OASIS, and billing data (we suspect that almost all current software does this already, our’s does.) If you aren’t in one of the 9 states it would still be a good idea to keep an eye on this and the measures that CMS is using to calculate the HHVBP. Data Soft Logic will be releasing the tools for everyone to track the necessary info for HHVBP by October of 2016 so our current clients in these states can some valuable reports, and our other clients can see how things work so that they are prepared in the case that the pilot program expands to their state.

How does this affect my payment!

While the pilot program reporting starts in 2016, there won’t be an adjustments in payments until 2018. The payments in 2018 will change based on performance scores of 2016. Heres a breakdown of what the payment adjustments could look like for agencies participating in HHVBP.

Max 3% up or down in 2018 based on 2016 performance scores
Max 5% up or down in 2019 based on 2017 performance scores
Max 6% up or down in 2020 based on 2018 performance scores
Max 7% up or down in 2021 based on 2019 performance scores
Max 8% up or down in 2022 based on 2020 performance scores
Keep checking back here regularly for any new info on HHVBP because if we know anything, it is that pilot programs tend to change and mold as they are implemented to deal with an unintended outcomes that might arise from the program ( we saw this with the delayed roll back of ICD-10). Whatever state you are in, its a good idea to keep an eye on this program because it may affect your agency in the future. We already work with some of the best data science companies in the industry, so if your agency is in a HHVBP state just ask us how we can help.


If you need some info on how to pick a software for your agency, check out our free buyer’s guide.