Home Health Articles and Information


Apr 29, 2021 7:44:54 AM / by Kristi Bajer, BSN, RN, COS-C

HHVBP's Unanswered Questions

There are still many unanswered questions regarding the expansion of home health value-based purchasing (HHVBP)…

Will it be in all 50 states?

Will new states phase-in or just enter at the 2022 +/-8 percent adjustment level? 

Will the data used in 2022 be the2020 data HHAs are submitting now?

The home health industry is anxiously awaiting the home health proposed rule which we hope will give us more guidance on the timeline and extent to the HHVBP expansion, but as we wait we have a very strong indicator HHVBP will expand to all states starting in January 2022.

The below comments are taken from the Certification of Home Health Value-Based Purchasing (HHVBP) Model…

“We were asked to consider a nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) Model. The considered expansion would simply apply the current model operating in 9 states to all states. Based on the formal evaluation of the first 3+ years of the program as well as our own analysis, I certify that the expansion of the HHVBP Model would reduce program spending….”


“The considered expansion of the program envisions a continuation of this model expanded to include all states. Since the model test produced statistically significant savings, we have concluded that an expansion of the model would produce Medicare savings. This would be true whether the expansion uses the same phase-in for payment adjustments (starting with +/-3 percent) as was done in the demonstration or jumps immediately to the same adjustment range currently being used in the demonstration states.”



If you are not in a current HHVBP state you may not have been paying much attention to HHVBP.  Below is some  basic information and history of HHVBP to get your agency caught up.

  • The home health model began on January 1, 2016 in nine states. Arizona, Florida, Iowa, Massachusetts, Maryland, Nebraska, North Carolina, Tennessee, and Washington.
  • Maximum payment adjustments started at 3% in 2018 (using 2016 data) and go up to 8% in 2022 (using 2020 data) are made based on the agency’s performance.
  • Initial metrics were three process measures, nine outcome measures, five satisfaction measures three agency reported measures 
              *** note- while STARS metrics share some overlap, HHVBP metrics are much broader
  • 2019 Final Rule made several changes to HHVBP metrics

           1) Removed two OASIS based process measures- Flu and pneumonia vaccine.

           2) Replaced improvement in bathing, bed transferring and ambulation which were judged on                               improvement, with a Total Normalized Composite (TNC) in six self- care items and TNC in                               three mobility items which are judged on overall magnitude of change.

           3) Reweighted the OASIS-based, claims-based, and HHCAHPS measures

           4) Reduced the maximum number of improvement points HHAs can earn for most                                                     measures from 10 to 9

 Click below for the CMS comprehensive guide.


Tags: PDGM, Value-based care, Compliance, Home Health, Quality assurance, Home Health Care

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.