Home Health & Hospice Week

What measures will your reimbursement depend on?

You can't just ignore pay for performance--the mechanism could determine your Medicare payment rates sooner than you think.

That was the message of multiple presenters at the National Association for Home Care & Hospice's annual policy conference in Washington, DC the last week of March.

The Centers for Medicare & Medicaid Services is shifting its payment policies for many provider types toward "quality and outcomes," noted Laurence Wilson, director of CMS' Chronic Care Policy Group, in a March 27 CMS panel on regulatory and policy issues. Pay-for-performance models are an important part of that focus, Wilson told attendees.

Be prepared: In particular, CMS plans a dem-onstration project to test a home care P4P model, Wil-son revealed. After thorough research and model testing, CMS would roll out a P4P model to the entire industry.

"This is really an imminent change in the payment system," agreed Sharon Bee Cheng, senior analyst for the Medicare Payment Advisory Commission, in a separate March 27 presentation focusing on P4P. Congress has essentially made up its mind to implement P4P and is merely working out the details now before passing requirements, Cheng told conference attendees.

Here are the major details a home care P4P model will have to nail down: • Measures. Congress and CMS must decide on which measures agencies will be judged--and paid. MedPAC recommends starting with the current outcome-based quality improvement (OBQI) measures agencies are using, particularly those on Home Health Compare, Cheng noted.

But P4P shouldn't end with OBQI measures, Cheng suggested. Instead, the program should evolve to include OBQM measures, patient "experience" measures and process-based measures, which MedPAC appears poised to endorse in its June report to Congress (see Eli's HCW, Vol. XV, No. 12).

Control issues: Providers actually prefer process measures because they have direct control over them, said Amanda Twiss, president of Seattle, WA-based benchmarking company Outcome Concept Systems, in the same presentation. On the other hand, many factors outside of an agency's control tend to influence patient outcome measures.

P4P measures should be well accepted by the industry, evidence-based, based on data collected with a standardized tool and risk adjusted, Cheng said. And providers should be able to improve on them. "We want as great an impact on as many patients as we can," she noted. Moving a score from 98 to 99 percent "is not a lot of bang for the buck." • Payment structure. The concept behind P4P is to reward providers for quality care, but how much is enough? P4P programs for private payors range from a 1 percent bonus to as much as 10 percent, Twiss noted.

MedPAC recommends starting with a small portion of payments that grows over time, Cheng said. A good place to start [...]