The 2024 Home Health Final Payment Rule, released on November 1, 2023, brings significant changes directly impacting the Value-Based Purchasing (VBP) model in 2025. We have summarized these changes and added some notes about their implications.
While VBP generally stays the same in 2024, maintaining the 2022 baseline, the changes will be brought about by the five outcome measures being replaced by three new ones. This shift will adjust the weight of individual items, affecting the Total Performance Scores (TPS). Importantly, the method for calculating HHCAHPS measures and their 6% contribution to the Total Performance Score remains unchanged.
- The new Discharge Function Score (DFS) will replace the existing Total Normalized Composite Change in Self-Care and Total Normalized Composite Change in Mobility measures, which depend on the 1800 items on the OASIS.
This new Discharge Function Score measure will be solely based on GG0130 and GG0170 items. Specifically, only Eating, Oral Hygiene, and Toileting Hygiene from GG0130 will be used in calculating this score.
The Discharge Function Score based on GG items, uses patient info from the Start of Care or Resumption of Care OASIS in a new CMS algorithm. This algorithm predicts the expected discharge status based on the documented patient status during SOC or ROC. If the agency’s reported discharge status matches or exceeds the algorithm’s calculation after submitting the Discharge OASIS, it leads to a positive measure outcome.
- A new Discharge to Community-Post Acute Care (DTC-PAC) measure, which will then utilize claims data, will replace the current OASIS-based Discharge to Community (DTC) measure.
This change impacts Value-Based Purchasing calculations, with the new measure using a 2-year data span instead of 12 months.
- A new single Potentially Preventable Hospitalization (PPH) measure will consolidate the existing Acute Care Hospitalization (ACH) and Emergency Department (ED) measures. The PPH, combined with the Discharge to Community-Post Acute Care Measure, will constitute the claims data for the VBP model.
Keep in mind that the PPH measure incorporates Observation stays. Consequently, if a patient under Home Health care undergoes an Acute Care Hospitalization or Observation stay, it will adversely affect the measure outcome.
- Both the Improvement in Dyspnea and Improvement in Management of Oral Medications measures will continue to be included in the model, but there will be a slight adjustment to their weight impact on the overall TPS.
Preparing for the Changes
The changes to the Value-Based Purchasing model pose a challenge and require staff education by 2025, particularly focusing on GG items. This is crucial for sustaining success in the VBP mode considering the newly introduced measures. Nationwide data indicates a lack of sufficient education for GG items in the OASIS compared to ADLs in the M1800 section.
Home health agencies should ensure that their staff receives sufficient education as early as possible. In addition, utilize QA audits to help ensure accurate responses to GG items and support continuous learning for clinicians.