What it takes to qualify – How many Providers will fail? – What can you Expect? – Is there life after failing to qualify for the VBP Bonus?
Home Health Value-Based Purchasing (VBP) Expansion arrived this year, and many Providers are eager to qualify for the bonus payment in 2025. Extensive education has outlined how the VBP model works, the relevant areas of the model measured for success, the schedule of performance and payments, etc. In addition, the new OASIS-E serves as the tool to measure VBP performance, adding an additional stressor to Providers in 2023. Today, we will share initial thoughts about the VBP Expansion, with a long-range look at what’s next and what HH Providers may confront moving forward.
Drilling down VBP Specifics for a look at the future
As HH Providers examine VBP specifics regarding benchmarks, Scoring, and clinical results, many realities become apparent. First, the concept that performance in VBP areas is directly tied to payment totals is entirely new to our industry. HH Staff, at all levels, will struggle to internalize the value of addressing VBP requirements. How will we inform front-line clinicians that VBP clinical recommendations differ from previous clinical initiatives, i.e. VBP programming items are required for success?
Next, under VBP, we are working in 2023 for bonus payments that we will not see until 2025. How successful will HH Providers be at playing the long game, keeping our eye on the ball (in an unprecedented manner) for a 2-year payoff? Under this model, will we be successful by monitoring metrics retro-actively? It seems unlikely this approach will elicit the type of care programming changes that will qualify for the 5% bonus. Finally, how will we manage our current HH staff to buy into the VBP approach, achieving programming results previously unseen in your agency?
What’s required for the VBP Bonus, and how many Providers will achieve bonus payments in 2025?
A cursory review of the VBP model, along with the scoring specifics, outlines a difficult path for Providers seeking the 5% bonus in 2025. Much of the scoring required for success are at levels not often currently seen in Home Health, including:
- Improvement in Dyspnea – 96.65%
- Discharge to Community – 83.43%
- Improvement Oral Med Management – 93.36%
- Totally Normalized Composite Score in Self-Care – 2.349
- Totally Normalized Composite Score in Mobility – 0.862
- 60-Day Rehospitalization – 8.98%
- 60-Day ED use – 6.10%
HHCAHPS scoring levels are similar, outlining levels of outcomes not often seen in today’s industry:
- Care of Patients – 94.7%
- Communications – 92.83%
- Specific Care Issues – 92.22%
- % who would rate9/10 – 93.95%
- % who would recommend – 90.89%
The implications of these VBP scoring requirements are obvious: many HH Providers will struggle to achieve bonus payment levels of any sort. An Operational rewire is required for success under the VBP model, assuring required performance levels are monitored in real-time. Currently, most Providers are not wired to perform real-time VBP metric tracking.
Finally, the VBP structure will only deliver the full 5% bonus payment to the top 10% of HH Providers, and more than 60% of all Providers will fail to achieve any VBP bonus payment level and will experience a 5% pay cut in 2025.
What’s next after you’ve failed to achieve the VBP Bonus payment levels?
As stated above, most HH Providers will fail to achieve the VBP bonus, unable to produce the elevated scoring levels above. What will they experience in 2025 and moving forward? From today’s perspective, HH Providers who fail to qualify for VBP will experience payment reductions of more than 8% by 2025 (2 Final Rules and VBP). With appropriate Operational management, HH Providers will be able to survive the lack of VBP bonus payments. By bringing care production and delivery management in-house (and out of the hands of front-line clinicians), Providers will be able to make the following changes to offset their episodic payment reductions:
- SOC OASIS Accuracy – employing the OASIS Guidance Manual for SOC collaboration
- POC production – assuring Value-based SN visits and FIL-based rehab POC
- IN-Episode Management – eliminate Case Conferences
- Missed Visit reduction – MVs water down care delivery
- Compliant programs – DC of non-compliant programs
- Full Productivity – for all clinical staff
As we move forward into the VBP era, we certainly have our work cut out for us. VBP scoring for success outlines a steep incline many HH Providers will fail to achieve. Every agency needs to develop a strategic plan to either achieve a VBP bonus level, or to prepare for a future defined by payment reductions. Get started on your VBP plan today to outline a path to success in the future.