Is Your Agency Going to Receive a Slice of the Pie?
Posted on March 01, 2010 in Coding Education
by Jennifer Warfield, RN, BSN, HCS-D, COS-C
If you have been around home health at all in the past three to four years, there is no doubt that you have heard about P4P (pay for performance). P4P has been in place in other areas of patient care for a couple of years and now it is homecare's time to be rewarded for providing outstanding care to its patients. What has been proposed is that bonus payments be awarded to HHA's (in their respective states) that ranked among the highest performance level in certain patient outcomes.
The HHP4P demonstration was done from January 2008 through December 2009 in seven states: Illinois, Connecticut, Massachusetts, Georgia, Alabama, Tennessee and California. Agencies choosing to participate in the demonstration did so on a voluntary basis. Incentives were made available based on improvement in patient status and actual monetary savings to Medicare.
The results: All participating agencies received their regular Medicare payments without any reductions. Additionally, incentive payments (a total of $15.4 million), is currently being awarded to HHA's that ranked in their respective state's highest performance level or highest level of improvement in patient outcomes. The $15.4 million was based on actual savings to the Medicare program because of better patient outcomes for 2008 only. Additional money will probably be available for outcomes in 2009 also.
What criteria were used in deciding on disbursements? Outcomes from OBQI data were used to evaluate this data. Since this data is automatically submitted for agencies that already submit OASIS data, there was no additional work required for participating agencies. These seven outcome measures were used in the demonstration:
1. Incidence of Acute Care Hospitalization
2. Incidence of Any Emergent Care
3. Improvement in Bathing
4. Improvement in Ambulation/Locomotion
5. Improvement in Transferring
6. Improvement in Status of Surgical Wounds
7. Improvement in Management of Oral Medications
The plan to go forward is currently being formulated whereby P4P will be instituted nationwide for all Medicare HHAs. So if you have wondered why CMS "makes such a big deal" about evaluating your agency's outcomes, wonder no more. $15.4 million looks like a big deal to me.
For more information on the demonstration, click on www.hhp4p.info.
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