Home Health Value-Based Purchasing (HHVBP): How to Document for Success

Home Health Value-Based Purchasing (HHVBP) is a nationwide Medicare payment model that ties reimbursement directly to the quality of care your agency provides. For Medicare-certified home health agencies (HHAs), effective documentation isn't just compliance—it's your pathway to financial stability, improved outcomes, and competitive advantage.

Here’s a clear, educational, and easy-to-follow guide to help your team document for success under HHVBP. For expert support and documentation strategies tailored to your needs, consider partnering with SummitRidge.

What Is HHVBP and Why It Matters

• Overview & Timeline
  Initially piloted in nine states from 2016 to 2021, HHVBP expanded nationwide starting January 1, 2022. The first full performance year was 2023, with payment adjustments—ranging from +5% to –5%—based on performance, applied in 2025.

• Model Objectives
  HHVBP is designed to improve quality, efficiency, and patient experience, while reducing avoidable hospital use and lowering Medicare spending.
  

Quality Measures & Scoring: What CBAs Need to Know

HHVBP uses three categories of metrics:

1. OASIS-based Measures

   • Improvement in dyspnea

   • Management of oral medications

   • Discharged to community

   • Function changes (TNC Self-Care & Mobility) and Discharge Function Score (CY 2025 onward)

2. Claims-based Measures

   • Acute care hospitalizations

   • ED visits without hospitalization

   • Potentially Preventable Hospitalization (PPH) within stay

   • Discharge to community post-acute care (DTC-PAC)

3. HHCAHPS Survey Measures

   • Patient perceptions: professional care, communication, overall rating, willingness to recommend, team discussion.
     

Scoring & Payment Adjustment

Each measure is weighted and combined into a Total Performance Score (TPS). Agencies earning high TPS may receive payment bonuses, while low scores result in penalties, up to ±5% of Medicare FFS payments.

How to Document for Success under HHVBP

1. Know and Track Your Baseline & Performance

• Understand Baseline Year

  • If certified before 2022, baseline is 2022; performance year is 2023; payment adjustments start in 2025.

• Monitor Performance Data

  • Use CMS’s iQIES platform to review Interim Performance Reports (IPRs) and Annual Performance Reports (APRs) for TPS and Adjusted Payment Percentage (APP).
    

2. Capture Complete and Compliant OASIS Documentation

• Ensure OASIS assessments at each relevant time point are accurate, timely, and reflective of patient progress—especially for self-care, mobility, dyspnea, and medication management metrics.
  

3. Monitor Claims & Utilization Patterns

• Track hospitalization and ED rates daily and link back to interventions like timely visits, telehealth check-ins, or enhanced medication education.
  

4. Maximize HHCAHPS Outcomes

• Train staff on patient communication and employ reminder tools (texts, emails, visits) to improve survey response rates.

• Encourage scripting that mirrors HHCAHPS language to align messaging with survey wording

5. Use QAPI for Continuous Improvement

• Integrate HHVBP measures into your QAPI processes—review data monthly, perform root-cause analysis, and implement action plans targeting low performance areas.
  

6. Invest in Data Infrastructure

• Leverage analytics tools or dashboards (e.g., within EMRs) to monitor measure performance, identify trends, and forecast potential payment adjustments.
  

7. Prepare Documentation & Team for Public Reporting

• Be ready for performance data publication via CMS’s Provider Data Catalog (PDC) and Care Compare.

• Have processes in place for recalculation and reconsideration requests if discrepancies appear in APRs

How SummitRidge Can Help

• Documentation Templates: Specialized tools to streamline capturing Hughes-based, claims, and HHCAHPS data.

• Performance Dashboards: Visualize TPS, trends, and alert teams proactively.

• QAPI Integration: Embed HHVBP measures into improvement initiatives with milestone tracking.

• Survey Readiness Support: Prepare for public reporting and any clarification requests.