Home Health Providers Should Be Aware

Value Based Purchasing (VBP) is the new payment model, authorized under the Affordable Care Act, to improve health outcomes and value by tying home health payments to quality performance. As of January 1, 2016, all Medicare-certified home health providers (HHP) that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee began participating in VBP.

The goal of VBP is to improve quality of home health care to Medicare beneficiaries and improve quality and efficiency by:

  • Incentivizing HHAs: better care/greater efficiency
  • Studying new measures in home health setting
  • Enhancing public reporting processes


Current provider action has mainly been limited to setting up CMS Portal accounts and training as the majority of the measures included in VBP were already being transmitted to CMS through existing processes and systems. Data for VBP comes from four places:

  1. OASIS
  2. CAHPS
  3. Claims
  4. New Measures entered via the CMS Portal


While no process changes were required for the data in the first three (OASIS, CAHPS, and claims), Home Health Providers (HHPs) will need to take action on the three new measures entered via the CMS Portal. HHPs will have the option of submitting the new measures to CMS via a Secure Portal beginning on October 1, 2016, for the period covering July 1 – September 30, 2016. New measure information will be submitted for each quarter throughout the Model and data entered for each period will include what is true for that data collection period only and will not be cumulative. While HHPs are not required to submit the new measures, it is important to note that if an HHP elects to not track/submit these three new measures, they will only be able to earn up to 90% of the total possible points for their Total Performance Score.

Home health providers should check with their software vendors to ensure their systems will be updated as needed.

HEALTHCAREfirst is in process of updating the Home Health Product lines to allow clients the ability to collect and track all data elements included in the three new measures:

  • June – During the month of June, HEALTHCAREfirst will roll out updates for all product lines. The updates will include changes that will allow tracking for:
  • Staff/Employee Influenza Vaccination
  • Patient Herpes Zoster/Shingles Vaccination
  • Patient Advance Directives –  Agencies should be aware that some elements of Advance Directives may only be located in patient legal documentation that may not stored within a providers Home Health software program.
  • July 1st – HH Providers opting to submit data on the three new measures, will begin collecting the data necessary for three new measures for submission to CMS beginning in October.
  • September – During the month of September, HEALTHCAREfirst will roll out a report for all product lines that will be used to submit the required data to the CMS portal. Currently CMS has only indicated that manual entry of the measures will be allowed. HEALTHCAREfirst will continue to monitor if CMS determines export files can be submitted versus manual entry.
  • October 1st – HH Providers opting to submit data for the three new measures, will begin entering the data into the CMS portal.


HEALTHCAREfirst will also make additional updates later in the year to the Business Intelligence tool that will allow all home health providers, even those not currently in a participating state, the ability to track the outcomes of their measures and monitor them real time.

Additional information on the new measures and on VBP can be found here: https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model