A new CMS project is looking at the role home health plays in improving quality of care for patients.
Home health agencies reimbursed by the CMS have begun a two-year pay-for-performance demonstration to determine the impact of incentives on improving quality of care for Medicare beneficiaries. About 600 agencies nationwide, representing 40% of all Medicare-certified home health agencies, are volunteering in the demonstration, which started Jan. 1 and runs through Dec. 31, 2009. The CMS hopes to distribute incentive payments that show improvement and high performance in key quality measures.
Participating agencies will be divided into a control group and an intervention group to test improvements of outcomes in seven measures: incidence of acute-care hospitalization, incidence of any emergent care, bathing, ambulation/locomotion, transferring, management of oral medications, and status of surgical wounds. Home health agencies will not have to collect any new data on these measures; the CMS will review existing data as they are submitted.
The demonstration is designed to be budget-neutralthe incentive pool will be generated out of savings from the expected reduction in the use of more costly Medicare services, and no one will receive lower payments to fund the incentives, according to the CMS.
The unique aspect of this demonstration is how it looks systematically at home health's role in reducing the number of hospitalizations for patients while increasing their care, said Theresa Forster, vice president for policy at the Washington-based National Association for Home Care & Hospice.
"It's a much more dynamic approach than used in other P4P demonstrations," which tend to focus on only specific points along the continuum of care, Forster said.
Ultimately the agency hopes the demonstration results in both reduced costs and higher quality of care for patients. "It's not enough" if Medicare just saves money as a result of the program, said Allison Henry, a CMS spokeswoman. If the demonstration does indicate that pay-for-performance impacts quality and cost, the program could become mandatory, although Congress would have the final say over any changes to reimbursement policies, Henry said.
The biggest improvement the agency wants to see is in reducing the number of times a patient must be admitted to an acute-care hospital, said J. Lee, home health program manager for the Alabama Quality Assurance Foundation. Often patients being cared for by home health agencies have frequent hospitalizations, which increases the cost to Medicare, he said.
The Birmingham-based quality improvement organization is the official Medicare QIO for Alabama. The CMS contracts with QIOs to oversee and improve Medicare quality, although for this demonstration the federal agency is working directly with home health agencies.
The demonstration will start to show home health agencies where they need to improve, Lee said. Pay-for-performance eventually will impact everyone across the healthcare industry and demonstrations such as the home health project start to weed out poor performers. "They know it's coming," he said.
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