Achieving Long-Term Success in CMS Value-Based Purchasing

Performance Year one is complete for Value-Based Purchasing (VBP), and we are waiting for the final Interim Performance Report (IPR) to be posted in July before the annual reports reveal whether your agency is getting a payment incentive for all your hard work, or if your money will be used to pay someone else for their efforts. Value-Based Purchasing is budget neutral so if the Centers for Medicare and Medicaid Services (CMS) gives money to the high achievers, that money will come from those whom did not do so well. This makes CMS value-based purchasing all the more critical to your practice’s sustainable profitability, and ensuring your Balue-Based Purchasing is in order can save you lost revenue later.

Value-Based Purchasing began its first performance year in January 2023, tracking agency performance in three areas — OASIS-based, claims-based, and HHCAHPS. Agencies (with a few exceptions) were compared to the baseline year of 2022. Agencies can gain achievement points by outscoring the median performance of their cohort in 2022, and they can earn improvement points by improving compared to their own 2022 performance.

In terms of value-based purchasing, CMS uses the higher of the point values as the agency’s care points. Some agencies are struggling in one area, and some are struggling in all areas. For example, we have seen agencies with good scores in acute-care hospitalization (ACH) and emergency department use (ED Use), great scores in the HHCAHPS but low scores in the OASIS-based realm. This indicates that their staff requires education in coding the OASIS because they are not scoring the patient accurately enough to satisfy requirements. The ACH score remains the most vexing at 26.25% of the total performance score (TPS).

In our recent webinar on improving ACH rates by drawing from industry best practices and research findings, we outlined strategies for mitigating ACH risks.

Strategies for Mitigating ACH Risks in Value-Based Purchasing

• Screening for risks, including social determinants of health
• Patient-specific care
• Proactive discharge planning
• Comprehensive case management
• Telephone follow-up
• Continuity of care
• Safety management

By adopting a multifaceted approach and integrating these strategies into their episode management programs, agencies can reduce ACH rates and improve patient satisfaction. In comparing ACH and ED Use to financial metrics like periods per episode and LUPA rates, we can identify key pain points that may be contributing to the ACH rates. Leveraging data analytics to track metrics, identify trends and guide performance improvement initiatives is a first step in developing strategies for keeping your patients at home.

Harnessing the power of data means that agencies can gain valuable insights into their operations, optimize resource allocation and drive continuous improvement. This is even more important with the upcoming changes to the measures in 2025, including the new Discharged to Community claims-based outcome.

Providing Expert Analysis to Turn Challenges into Achievements

McBee has reviewed well over 350 IPRs (Interim Performance Reports) and engaged in enlightening conversations about what works and what does not in Value-Based Purchasing. If you need assistance in understanding your reports, analyzing the results and digging deep into your data, call on McBee to help your agency strategize and recognize your rewards under Value-Based Purchasing.