Home Health

CMS updates HHVBP FAQ for April

CMS is providing more resources for agencies as it prepares for implementation of the national rollout of the Home Health Value-Based Purchasing (HHVBP) model beginning in 2023.

In a message to providers April 7, 2022, CMS highlighted updates to its HHVBP Frequently Asked Questions, with the FAQ growing to 45 pages.

Among the new and updated FAQs:

Q. Why are the measures Acute Care Hospitalization During the First 60 Days of Home Health (ACH) and Emergency Department Use Without Hospitalization During the First 60 Days of Home Health (ED Use) weighted higher than other measures?

A. CMS places a higher weight on the ACH measure because it reflects a more severe health event and because inpatient hospitalizations generally result in more Medicare spending than the average emergency department visit that does not lead to an acute hospital admission.

Q. Have the risk adjustment models been established for the quality
measures included in the HHVBP Model?

A. The established risk adjustment methods vary by OASIS-based, claims-based, and HHCAHPS measures.

In general, CMS conducts the risk adjustment process in three stages for each quality outcome for the OASIS-based and claims-based and measures:

  1. Building the prediction model – A statistical model is created to predict the outcome of a home health patient for a given quality outcome.
  2. Aggregating the results to the agency level – The observed and predicted rates for each home health outcome are aggregated for each agency (e.g. CCN level).
  3. Applying the risk adjustment algorithm – The HHA’s observed rate is adjusted by the difference between the national predicted and the HHA’s predicted rates.

The risk adjustment process for HHCAHPS survey-based measure is different from the process described above. Please refer to the document titled Patient-Mix Adjustment Factors for Home Health Care CAHPS Survey Results Publicly Reported on Care Compare in January 2022 on the HHCAHPS website that outlines the risk adjustment process for HHCAHPS measures in detail.