As previously reported, the 2024 home health (HH) Medicare payment rates became effective January 1, 2024, with an estimated aggregated increase in payments of only 0.8%. January 1 also marked the beginning of the second year of CMS’ national expansion of the HH Medicare Value-Based Purchasing (VBP) demonstration project, which offers HH agencies an opportunity to improve Medicare payments.
The national expansion of HH VBP applies to all Medicare-certified HH agencies and was implemented January 1, 2023. HH agencies’ VBP performance in 2023 will determine up to a 5% positive or negative adjustment to Medicare payments in 2025, while performance in 2024 will determine up to a 5% positive or negative payment adjustment in 2026.
The VBP performance measures in 2024 remain unchanged and continue to include five based on the Outcome and Assessment Information Set (OASIS), two claims-based measures, and five HH Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey-based measures. However, the final rule did establish changes for 2025, including the following:
- The five OASIS-based performance measures will be reduced to three by removing the discharged to community, total normalized composite (TNC) change in mobility, and TNC change in self-care measures and adding a new discharge (DC) function measure.
- The two current claims-based measures will be replaced by two new measures, including potentially preventable hospitalization and discharge to community—post-acute care (DTC-PAC).
The HHCAHPS survey-based measures remain unchanged. The following table summarizes the performance measures and associated weights for 2024 and 2025.
| 2024 Measure Weights | 2025 Measure Weights | |||
|---|---|---|---|---|
| Performance Measure | Larger-Volume Cohort1 | Smaller-Volume Cohort2 | Larger-Volume Cohort1 | Smaller-Volume Cohort2 |
| OASIS-Based Measures | ||||
| Discharged to community3 | 5.833 | 8.333 | - | - |
| Improvement in dyspnea | 5.833 | 8.333 | 6.000 | 8.571 |
| Improvement in management of oral medications | 5.833 | 8.333 | 9.000 | 12.857 |
| TNC change in mobility3 | 8.750 | 12.500 | - | - |
| TNC change in self-care3 | 8.750 | 12.500 | - | - |
| DC Function4 | - | - | 20.000 | 28.571 |
| Sum of OASIS-based measures | 35.000 | 50.000 | 35.000 | 50.000 |
| Claims-Based Measures | ||||
| Acute-care hospitalization3 | 26.250 | 37.500 | - | - |
| Emergency department use without hospitalization3 | 8.750 | 12.500 | - | - |
| Potentially preventable hospitalization4 | - | - | 26.000 | 37.143 |
| DTC-PAC4 | - | - | 9.000 | 12.857 |
| Sum of claims-based measures | 35.000 | 50.000 | 35.000 | 50.000 |
| HHCAHPS Survey-Based Measures | ||||
| Care of patients | 6.000 | 0.000 | 6.000 | 0.000 |
| Communications between providers and patients | 6.000 | 0.000 | 6.000 | 0.000 |
| Specific care issues | 6.000 | 0.000 | 6.000 | 0.000 |
| Overall rating of HH care | 6.000 | 0.000 | 6.000 | 0.000 |
| Willingness to recommend the agency | 6.000 | 0.000 | 6.000 | 0.000 |
| Sum of HHCAHPS survey-based measures | 30.000 | 0.000 | 30.000 | 0.000 |
| Sum of all measures | 100.000 | 100.000 | 100.000 | 100.000 |
CMS provides HH agencies with Interim Performance Reports (IPRs), the most recent of which was released in January. The IPRs allow HH agencies the opportunity to track and trend performance in each of the 12 measures. HH agencies should take advantage of the IPRs and utilize them to target those measures that offer the most opportunity for improvement and incorporate such into their Quality Assurance and Performance Improvement (QAPI) programs.
With the potential to improve Medicare revenues by up to 5%, VBP offers a substantial opportunity to those HH agencies able to outperform others within their national cohort, or at least improve over their own prior-year performance. Conversely, those HH agencies whose performance does not keep pace with peers or show improvement will face a reduction in payments.
CMS has extensive resources available to HH agencies online, including training materials, QAPI tools, etc. If you have any questions or need assistance, please reach out to a professional at Forvis Mazars.
- 1 a b Larger-volume cohort includes HH agencies with 60 or more unique survey-eligible beneficiaries in the calendar year prior to the performance year.
- 2 a b Smaller-volume cohort includes HH agencies with less than 60 unique survey-eligible beneficiaries in the calendar year prior to the performance year.
- 3 a b c d e Performance measure no longer used in 2025.
- 4 a b c Performance measure new for 2025.