Communication with Patients linked to High Points in Home Health Value Based Purchasing

In HHCAHPS will become a major driver of value when calculated in the TPS scoring. Those items include:

HHCAHPS Survey-based

• Care of Patients/Professional Care
• Communications between Providers and Patients/Communication
• Specific Care Issues/Team Discussion
• Overall rating of home health care/Overall Rating
• Willingness to recommend the agency/Willing to Recommend

In this blog, we will look at just how Remote Care Monitoring (RCM) can add significant value to the new Home Health Value Based Purchasing (HHVBP) expected to begin in 2023.  HHCAHPS surveys will take on an entirely new level of importance as agency’s struggle to get HHCAHPS scores to a level necessary the to capture significant points in determining the value of care provided.

As an overview, in early November, the Center for Medicare and Medicaid (CMS) released information through the final rule indicating just how payment for services will change from a volume-based program o one that will pay the Agency based on the value of care provided.  This is a long-awaited payment system presented following years of demonstrations in 9 different states.  The success in dollars saved with this demonstration was so significant, CMS cut the demonstration short and now expands to all States and all enrolled providers.

There was an initial intent, by CMS, to Value Based Purchasing in 2022.  However, the pandemic and other issues were found impeding to such a degree that the start of VBP is determined to be 2023 as the first performance year and 2025 will mark the official ‘payment adjustment’ year.  These adjustments are based on the Agency’s performance in a particular year related to quality measures relative to another agency’s grouped in the same cohort.  A -5% to +5% of the fee-for-service payments will be adjusted based on specific outcomes.  

Adjustments allocated in the agency’s Total Performance Score (TPS) within a “performance year”, includes collected data extrapolated from:

 (1) OASIS: Outcome and Assessment Information Set (OASIS), 

(2) HHCAHPS:  Home Health Consumer Assessment of Healthcare Providers and Systems 

(3) Claims-based measures (e.g., acute care or ER hospitalizations during the first 60 days of HHA use). 

Using a robust RCM system, an agency can improve HHCAHPS  scores significantly.  

A close connection with patients is critical.   While there is nothing that can replace a physical connection with patients, communicating is the very next best thing.  Telephone communication can be of some help, but being able to actually see the person and the person having the ability to actually see the professional, is key to successful interaction.

As we a look at each item in the HHCAHPS grading, there are a number of things agencies can do to improve the outcome scores relative to the HHCAHPS survey.

• Care of Patients/Professional Care– With a well-equipped RCM program, the agency can add significant time with the patient remotely.  24-hour availability should be a targeted area when researching RCM programs.  Connected Home Living is such a program monitoring patients 24 hours a day and 7 days a week.  The “Face to Face” requirement is easily met for homecare and hospice using RCM, since the process uses virtual visualization of the patient during the session. Patients and their families can rest assured professional care is as simple as touching an application on their device in to receive expedient care needed.  Experienced para-professional “Remote Care Coordinators” (RCC’s) are available around the clock to receive patient requests, respond to medical needs and escalate to assigned RN’s, Physicians, or other team members as necessary.  The peace of mind with knowing help is at their fingertips is immeasurable. Professional care is accessed urgently any time needed.

• Communications between Providers and Patients/Communication

Communication with family, patients and providers is on-going.  Clinical reports based on data collected using monitoring devices such as weight scales, glucometers, vital signs, etc., are easily transmitted to providers or legal representatives.  

• Specific Care Issues/Team Discussion. Clinical case conferences are so very important to care excellence. Using RCM for care conferencing/team meetings is quick and easy.  No need to set in person meetings with busy professionals.  Families can take part in team meetings by simply dialing in to the face to face meeting.  Often family members are hundreds of miles away and cannot attend meetings.  RCM makes these sessions available for everyone in the circle of care to attend these important discussions.

• Overall rating of home health care/Overall Rating.  This is an area CMS has found is often not answered at all or with very low scores.  Using RCM as a way of communicating with patients is one of the best ways to achieve the goal of satisfaction with patient care overall.  Studies have shown that the frequent contact with the patient, the higher the satisfaction with the scores.  RCM is an easy way to have that fulfillment of needs and individual goals met.  Data collection on overall patient satisfaction by the RCM provider and shared with families and patients can improve the response rate in this area.

• Willingness to recommend the agency/Willing to Recommend.  This is another area where CMS finds low response rate in HHCAHPS scoring.  Again, more frequent contact with patients and their families will certainly improve recommendation rates for agencies when using a remote care option that is active in patient engagement and response. Satisfaction responses can be measured by the RCC and shared with patients and families as a pre-emptive report to the receipt of the official HHACAPs form from CMS. 

Summary

In summary we need to understand what agencies need to consider over this next year to get ready for this massive change in the way we will be paid.  At discharge, it is important to keep patients informed and educated. RCM is one primary way to position the Agency for success.

Be sure to educate the patient throughout their homecare experience. 

Assure patients and families understand and are informed on:

• Patient condition
• Medications
• Discharge plans
• Follow-up appointment’s

Should the patient choose to continue with RCM services at discharge, the patient and family will feel empowered and satisfied with their experience. RCM can assure future symptom education can be assured through RCM Podcasts or YouTube Videos.  With ongoing RCC monitoring, the Agency can be assured that if exacerbation occurs, the Agency can be contacted for review of eligibility for additional admission.

Overall based on multiple studies, patient satisfaction is closely related to patient use of remote care monitoring.  The most satisfaction is found when the experience is delivered through videoconferencing as opposed to telephone (no visual) contact.  Telehealth is quickly evolving, and CMS is closer than ever to reimbursing for the service.  Agencies should use this year of VBP “implementation” to do the research necessary to explore the best RCM available.  Those who do will find improved satisfaction rates, improved reporting to CMS via HHCAHPS, and the best patient outcomes possible.