I recently returned from the National Association of Home Care’s (NAHC) Financial Management Conference in Nashville, and it looks like July is going to be a busy month. The hot topic was the Home Health Value Base Purchasing (HHVBP) pilot, just published by CMS in the Home Health Proposed Rule released on Monday, July 6th. This month, the new 30-day readmission rates will also be posted on Home Health Compare (HHC), the new Star Ratings will be added for Quality of Patient Care, and the new PEPPER reports will be made available via the CASPER system.
Which measures will CMS use for the HHVBP program? CMS has proposed 10 process and 15 outcome measures, along with 4 New Measures. Given how much scrutiny 30-day readmissions have received across the health care industry, I don’t think that it’s much of a leap to think these rates will also be included in VBP sometime in the future. In their HHVBP report to Congress, the Department of Health and Human Services (HHS) noted the need to “…coordinate the home health VBP program with other existing VBP, pay-for performance, quality monitoring and public reporting systems”. Hospitals are already being penalized for 30-day readmissions, and Skilled Nursing Facilities (SNF) will see penalties/bonuses when the SNFVBP is started in Fiscal Year 2019. In May, I blogged about how 30-day readmissions across the last four years had decreased, with the exception of 2013 to 2014.
What are some of the 30-day readmission correlations with OASIS patient characteristics that we may be able to learn from? I recently presented some of these findings at the VNAA annual conference in New Orleans. Some of the correlations are interesting and expected, but the real question is, how will agencies react when penalties and bonuses are on the line? For example, I was interested in looking at the correlation between 30-day readmissions and behavioral health factors, such as the M1730 PHQ scoring when used for Depression. As I expected, the higher the number of days the patient was depressed in a two week period, the higher the readmission rate.
|Depressed last two weeks||30-Day Readmissions|
|Depressed - 0-1 day||11.92 %|
|Depressed - 2-6 days||16.41 %|
|Depressed - 7–11 days||17.92 %|
|Depressed - 12–14 days||18.43 %|
|Depressed - Unable to respond||17.55 %|
SHP Database: CY 2011 – CY 2014 Medicare episodes
The key question will be, which resources will agencies deploy to help decrease the likelihood of readmission in these instances? There is a lot to consider once the details of the HHVBP are known. As we said, July is going to be a busy month! Please join me on July 15th at 2:00 EDT for our next Wednesday Winning Webinar: A Deep Dive into the Data behind Hospital Readmissions, to learn more about these correlations.