First BPCI Report Highlights (Likely) HHA Value
While this isn't going to be very surprising to industry leaders, I'm highlighting this report as an opportunity to demonstrate the considerable value and innovation of home-based care. I say "likely" because the first report, released last week, evaluates only three months of 2013 (4Q13).
The Centers for Medicare and Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) Initiative in January 2013, but the initial round of awardees didn't get started until later that same year. The report, found here, examines that first operational quarter and projects slightly into 2014. Regardless, the analysis and findings bode well for home health and we will closely monitor this program and the more than 22 VNAA member sites who are participating in the Model 3 bundle
A bit of background: the report examines first quarter program data for BPCI Models 2, 3 and 4. Models 2 and 4 are geared toward hospital-level awardees and Model 2 includes post-acute care (PAC) services. While PAC providers don't control the bundle in this model, the analysis finds they contribute to the success. Model 3 is available to other providers, including home health agencies, skilled nursing facilities and other post-acute care settings.
The key finding of interest to VNAA members: Analysis across models observes statistically significant declines in SNF use and increases in HHA use, which could indicate substitution of the lower cost HHA care for the higher-cost SNF stays. This would appear to align with earlier analyses that find home health and skilled nursing have similar quality outcomes but that home health is less expensive.
For Model 2 sites, the most common clinical episode was major joint replacement of the lower extremity and that the majority of HHA episodes for Model 2 were for orthopedic surgical episodes excluding spine. The report notes that subsequent operational quarters not analyzed in the report saw other frequently selected clinical episodes including CHF, COPD, and pneumonia. All Model 2 episodes observed changes in the anchor hospitalization LOS (reduction) and use of PAC (increase). Further, the analysis observed a four percent decline in discharge to SNFs and a six percent increase in discharge to HHAs. Finally, HHA payments for BPCI patients increased from the baseline to the intervention period while declining for comparison patients.
For Model 3 sites, only one HHA participated in 4Q13 but expanded significantly in 1Q14. As such, HHA results are not presented in the first report due to the small sample size. However, the report does note that the only Part A payment difference between BPCI SNF initiated episodes and comparison patients that was significant was for home health care. Specifically, average Part A payments for HHA services increased significantly more from baseline to intervention for BPCI patients relative to comparison group patients during the 90-day post discharge period.
VNAA will keep close tabs on the findings for Model 2 initiatives and our member-agency Model 3 sites for future findings. More to come.