P4P is moving into the home health arena. Later this month, CMS plans to roll out a two-year HHA P4P demonstration project in seven states: CT, MA, AL, GA, TN, IL and CA. The key indicators to be tracked as part of the demo are drawn from standard quality measures already included in the CMS HHA Outcome-Based Quality Improvement (OBQI) data set. They are:
- Incidence of Acute Care Hospitalization
- Incidence of Any Emergent Care
- Improvement in Bathing
- Improvement in Ambulation/Locomotion
- Improvement in Transferring
- Improvement in Status of Surgical Wounds
- Improvement in Management of Oral Medications
Payments will be tied to both high performance (a la HQID) and performance improvement. Unlike other P4P demonstration projects (e.g., the gainsharing demos), for this project, there’s talk of random assignment to control vs. study groups. Also, payment will be conditioned on reduced overall Medicare spending. Thus, unlike participants in the gainsharing demos, HHAs will not be put at financial risk by implementing higher-cost program modifications designed — but not guaranteed — to yield performance improvement and/or cost savings.
Abt Associates has been in involved in the demo design, and an Abt presentation at an HHA P4P open door session is up on the CMS website (click on open door ppt download).