CMS is sharing savings with 166 Home Health Agencies (HHA) based on their performance during the first year of the Medicare Home Health Pay for Performance (HHP4P) demonstration.
The two year demonstration which began in 2008, and ended December 2009, showed the impact of financial incentives on the quality of care provided to home health patients in traditional fee-for-service Medicare and their overall Medicare costs. Savings are being shared with agencies that either maintained high levels of quality or made significant improvements in quality of care.
All Medicare-certified home health agencies in seven states representing four census regions were invited to participate in the demo. The Northeast region includes HHAs in Connecticut and Massachusetts, the South included HHAs in Alabama, Georgia, and Tennessee, and the Midwest and West regions included HHAs in Illinois and California.
HHAs that volunteered were randomly assigned to either an intervention or control group. Performance was measured using seven home health quality measures computed from the Outcome-Based Quality Improvement data set and listed on the Home Health Compare Web site.
Each measure evaluated the performance of the HHA’s for the quality and efficiency of care provided to traditional Medicare patients. Each HHA in the intervention group was compared only to other intervention agencies within the same state.
For each measure, HHAs ranked by performance in the top 20 percent in their state, as well as those demonstrating the greatest degree of quality improvement were eligible to share in Medicare savings generated in their region.
Medicare savings for the demo were determined by comparing total Medicare costs for beneficiaries receiving care from the intervention group’s HHAs with the costs for beneficiaries served by the control groups HHAs in the same region. These costs include Medicare payments for home healthcare, inpatient hospital care, nursing home, and rehabilitation facility care, outpatient care, physician care, durable medical equipment, and hospice care.
If no savings were generated in a region, no incentive payments were made in that region. Results for 2008 produced an aggregate Medicare savings of $15.5 million for three of the four regions. The Midwest region did not achieve any savings.