hhvbp deep dive into the data and cy 2019 changes conference/pp...hhvbp •5 year pilot starting...
TRANSCRIPT
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1
2019 Home Care Conference
Home Care Association of Washington
May 1, 2019
HHVBP – Deep
Dive into the Data
and CY 2019
Changes
Chris AttayaVP of Product Strategy
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Agenda
• HHVBP Overview
• CMMI First Annual Report
• CMMI Payment and Adjustment Reports – PY 2017
• Final Rule on HHVBP for PY 2019
• VBP Trends through Calendar 2018
• Data on the New Composite Metrics
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HHVBP Overview
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HHVBP
• 5 year pilot starting with Performance Year in 2016
• Bonus or penalty up to 3% first year then - 5%, 6%, 7%, 8%
• Baseline Year of 2015 used for calculating the median (achievement threshold) and mean of top decile (benchmark)
• Baseline scores are state specific
• For CY 2016/2017 - 17 OASIS/Claims/HHCAHPS measures used along with 3 New Measures
• Up to 10 Points for Achievement and Improvement for each measure – get the higher of the two
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Measures by NQF Domain (PY ’16, PY’17)
DOMAINS
1) Patient and Caregiver Centered Experience 2) Clinical Quality of Care
3) Communication & Care Coordination 4) Population Health
5) Efficiency and cost reduction 6) Patient Safety
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Points on Achievement and Improvement
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Total Performance Scoring (TPS)
• 17 OASIS/HHCAHPS/Claims based measures are used in the TPS unless an agency does not have 20 or more episodes per measure - Accounts for 90% of the score
• Three “New Measures” account for the 10% of the score
• If an HHA does not meet this threshold to generate scores on five or more of the Clinical Quality of Care, Outcome and Efficiency, and Person and Caregiver-Centered Experience measures, no payment adjustment will be made
• Bonus and Penalties are based on the relative position of your TPS scores to the other providers in your cohort (large or small)
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Total Performance Scoring (Cont.)
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Total Performance Scoring (Cont.)
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TPS Scoring – Linear Exchange Function
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TPS Examples
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CMMI First Annual Report
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CMMI First Annual Report on HHVBP
Published in July 2018 including 67 agency interviews
Key Findings
• Overall improvement in TPS scores• Both HHVBP and non-HHVBP agencies saw improvements
• Non-HHVBP agencies may have been responding to CMS Star Ratings
• TPS scores increased 2.3 points more in HHVBP agencies than comparison agencies
• TPS scores increased 7.4% over the base-line year
• Mixed results for Medicare spending and utilization• The incentives to change behavior in this first year are weaker because
CY 2016 is a performance year rather than a payment year
• Observed no statistically significant change in unplanned hospitalizations
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CMMI First Annual Report on HHVBP (Cont.)
• Mixed findings on effects for OASIS-based measures• Observed improvements in the four functional measure• No difference changes in the other three OASIS quality outcomes• Noted improvements in three OASIS process measures
• No evidence of HHVBP impact on patient experience measures• Patient experience has been stable over time• No differential changes between CY 2015 to 2016
• Early changes in HHA operations were relatively focused and similar to ongoing activities• Agencies did not necessarily shift strategies in response to HHVBP since
quality improvement efforts for CMS Star Ratings and Public reporting of HHC were already underway
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CMMI First Annual Report on HHVBP (Cont.)
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CMMI First Annual Report on HHVBP (Cont.)
Conclusions
• Largest increases in quality scores were among the four OASIS functional improvement outcome measures
• Outcome improvement may be more related to better accuracy in OASIS scoring
• No detectable impact of HHVBP on home health patient outcomes, utilization, or Medicare spending during the first year
• Behavior may change as payment adjustments are known and as the incentives increase over the 5 model years
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CMMI Payment and Adjustment Reports –
PY 2017
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Source: CMS Final TPS Adjustment Report PY2
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Source: CMS Final TPS Adjustment Report PY2
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Source: Home Health Compare – Oct 2018 refresh
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Source: CMS Final TPS Adjustment Report PY2
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Final Rule on HHVBP for PY 2019
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Changes in HHVBP since first year
• CY 2018 Final Rule• Change the HHCAHPS to 40 completed surveys versus 20
• Removed Drug Education from measure list starting in CY 2018 (third performance year)
• Four of the nine states have both small and larger volume cohorts (NE, IA, FL, MA)
• CY 2016 first year performance was not finalized until October 2018 when the final rule was issued
• Uncertainty in knowing how to budget for your bonus/penalty
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Measures by NQF Domain (PY 3)
DOMAINS
1) Patient and Caregiver Centered Experience 2) Clinical Quality of Care
3) Communication & Care Coordination 4) Population Health
5) Efficiency and cost reduction 6) Patient Safety
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CY 2019 Final Rule - HHVBP
• Removing 5 OASIS measures from the applicable measures• Influenza Immunization Received for Current Flu Season• Pneumococcal Polysaccharide Vaccine Ever Received• Improvement in Ambulation-Locomotion• Improvement in Bed Transferring• Improvement in Bathing
• Adding two new “Composite” measures• Total Normalized Composite Change in Self-Care (6 outcomes)
• Grooming, Bathing, Upper and Lower Dressing, Toileting Hygiene, Eating
• Total Normalized Composite Change in Mobility (3 outcomes)• Toilet Transferring, Bed Transferring, Ambulation
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CY 2019 Final Rule – HHVBP (Cont.)
• New Weighting for the measure scores for 90% of the TPS • 35% for the OASIS-based measures (6 outcomes)
• 35% for the Claims-based measures (2 outcomes)• 75% 60-Day Hospitalization, 25% ED use without Hospitalization
• 30% for the HHCAHPS measures (5 outcomes)
• Weighting will be adjusted within each category for measures not meeting the reporting threshold
• The two composites will be weighted as if 3 measures (15 points each)
• Reducing the maximum points for Improvement from 10 points to 9 points (13.5 points for the composite measures)
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Re-Weighting Distribution
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HHVBP New Scorecard
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Changes in TPS with 60 Day ACH Only
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Change in Improvement Points
9 x - 0.5
• Reduces the maximum amount of improvement points, from 10 points to 9 points, for PY4 and subsequent performanceyears
• Exception is for the Total Normalized Composite Change in Self-Care and Total Normalized Composite Change in Mobility measures – 13.5 points (90% of 15 points) would be possible
Update Formula:
HHA Performance Period Score – HHA Baseline Period Score
Benchmark – HHA Baseline Period Score
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Measures by NQF Domain (PY 4)
DOMAINS
1) Patient and Caregiver Centered Experience 2) Clinical Quality of Care
3) Communication & Care Coordination 4) Population Health
5) Efficiency and cost reduction 6) Patient Safety
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TNC Measure Calculation
• The magnitude of possible change depends on the response score of the OASIS Items
Response Options: 4
Max (+) Change: +3
Max (-) Change: -3
Response Options: 7
Max (+) Change: +6
Max (-) Change: -6
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TNC Measure Calculation Steps
Computed and normalized at the episode level, then aggregated to the HHA level using the following steps:
Step 1: Compute Absolute Change for each OASIS item by Episode• Subtract discharge response value from SOC/ROC response value for each OASIS
item
Step 2: Compute Normalized Change for each OASIS item by Episode• Divide the absolute change by the maximum positive change possible for each
OASIS item
• Normalized change ranges from -1 to +1 by OASIS Item
Step 3: Sum the Normalized Changes across All OASIS items by Episode• Sum the normalized scores for each OASIS item in each composite measure (TNC
in Self-Care ranges from -6 to +6; TNC in Mobility -3 to +3)
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Composite Measure Calculation (cont.)
Step 4: Average the HHA’s Episode-level TNC Values• HHA’s averages range from -6 to +6 for TNC in Self-Care and from -3 to +3
for TNC in Mobility
Step 5: Compute the HHA’s risk-adjusted TNC Measure• Formula: HHARisk Adjusted = HHAObserved + (NationalPredicted – HHAPredicted)
Note: Baseline year for the two composite measures will be CY 2017
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TNC– Self-Care: Achievement Threshold (AT) and Benchmarks (BM)
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TNC– Mobility: Achievement Thresholds (AT) and Benchmarks (BM)
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Composite Measure Postings
• The April 2019 IPRs will contain your agency’s baseline values and state’s Benchmarks and Achievement Thresholds for the two composite measures
• The 2019 Annual Report (PY3) will not include these changes
• Composite Measures and all PY 2019 changes will be included beginning in the July 2019 IPRs
• Technical documentation on risk-adjustment coefficients is expected to be published on HHVBP Connect in mid-2019, including:• Pseudo code
• List of risk factors
• Risk-adjustment coefficients
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What is my target?
Wayne Gretzky Quote:
“I skate to where the puck is going to be, not where it has been”
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Setting your target
Source: CMS Star Rating Cut Points
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Changes in the 9 HHVBP States (Examples)
Source: SHP National Database
• 12 months ending December
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Changes in the 9 HHVBP States (Examples)
Source: SHP National Database
• 12 months ending December
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Year over Year HHVBP Measures
Source: SHP National Database
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HHVBP TPS Scores
Source: SHP National Database
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Measure Trends – VBP States TPS Scores
Source: SHP National Database
• Changes in TPS scores Dec 2016 to Dec 2017
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Raw Scores Distribution in VBP States
Total Normalized Composite: Mobility
Source: SHP National Data – CY 2018
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Raw Scores Distribution in VBP States
Total Normalized Composite: Self Care
Source: SHP National Data – CY 2018
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Raw Scores Distribution in Washington
Source: SHP National Data – CY 2018
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Average Raw Scores in Washington by Measure
Source: SHP National Data – CY 2018
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Achievement Points Comparison: TNC Self-care and Mobility to Ambulation, Bed Transferring and Bathing (max 30 points each)
Source: SHP National Data – CY 2018