In the News: Home Health Demonstration Pay For Performance [P4P] Project Update

The Department of Health & Human Services, Centers for Medicare & Medicaid Services recently released an update on the Home Health P4P Demonstration Project. This project’s implementation date was January 1, 2008 and the call for home health agency [HHA] participants was released in the fall 2007. The solicitation for participants was limited to seven states. From these states, [1] Alabama, [2] California, [3] Connecticut, [4] Georgia, [5] Illinois, [6] Massachusetts, and [7] Tennessee, 569 home health agencies [HHA’s] volunteered and were selected to participate in this project.

This group of selected participants represents a broad cross section of home health agency [HHA] type and structure including diverse geographic [urban and rural] locations, size [small, medium and large] and structures that include nonprofit, government and proprietary organizations, freestanding and hospital-based facilities. In terms of volume, these selected agencies represent more than thirty percent of all Medicare-certified HHA’s in the selected states. These 569 home health agencies also account for more than half [i.e. fifty-five percent] of Medicare home health episodes in these seven states.

Within this group of 569 agencies, agencies have been randomly assigned to either the demonstration study or the control group. Agencies within the study group have their patients’ outcomes monitored through the demonstration project, which is scheduled for a two-year time period. As a result of achieving either the greatest improvement in patient outcomes and/or demonstrating the highest level of quality among participants within the states, the individual agency becomes eligible for incentive payments.

There are seven quality measures included in this demonstration project study, all of which are taken from the current Outcome-Based Quality Improvement (OBQI) data set. These measures evaluate participating agency performance and are also reported on every HHA [not just the agencies participating in the demonstration project] in the Home Health Compare quality online reporting. The measures selected for this demonstration project are:

• Incidence of Acute Care Hospitalization
• Incidence of Any Emergent Care
• Improvement in Bathing
• Improvement in Ambulation/Locomotion
• Improvement in Transferring
• Improvement in Status of Surgical Wounds
• Improvement in Management of Oral Medications

One caveat relative to the distribution of incentive payments is that concurrently with the improved patient outcomes or higher levels of care quality, there must also be demonstrated an overall cost savings to the Medicare program. Examples of how and where these savings might occur include utilization reductions in other care settings, such as acute care hospitals, emergency rooms, nursing facilities, and other Medicare-covered services.

As this demonstration project moves forward, comparisons of individual patient outcomes are being monitored to further demonstrate that improvements are maintained and sustained.  Updated reports on quality and outcome improvement will be issued, which will include additional information on any incentive payments made as a result of the improvements and cost savings.

Scrutiny of the updated reports on this demonstration project are of interest and importance to the entire industry, as the results demonstrated and resultant actions taken have the potential to affect the entire home care provider base’s reimbursement for a long time. In addition, if significant findings result from this study, it is anticipated that the P4P reimbursement model will be adapted for other health care provider settings.

For ongoing and future project updates agency leaders should access http://www.cms.hhs.gov/DemoProjectsEvalRpts/downloads/HHPP_Implementation_Update.pdf.