P4P project looks at quality and savings

OASIS measures used for evaluation

The Centers for Medicare & Medicaid Services' Home Health Pay for Performance (P4P) demonstration started in January 2008 and concluded December 2009. States included in the demonstration were: Connecticut, Massachusetts, Illinois, Alabama, Georgia, Tennessee, and California. The states were divided into four regions. The 570 agencies that volunteered to participate were randomly assigned to either the treatment group or the control group of the demonstration.

An incentive pool generated by savings accrued from the reduction in the use of more costly Medicare services was used to pay bonuses to agencies that produced the highest patient care ratings or produced the greatest improvements in patient care as measured by seven OASIS [Outcome and Assessment Information Set] measures. Only agencies in the treatment group were eligible for incentive payments, says Bill Buczko, PhD, CMS project officer for the evaluation of the P4P project. The OASIS measures used for the demonstration are:

• incidence of acute care hospitalization;

• incidence of any emergent care;

• improvement in bathing;

• improvement in ambulation/locomotion;

• improvement in transferring;

• improvement in status of surgical wounds;

• improvement in management of oral medications.

Home health agencies are already collecting the information used to evaluate quality of outcomes through OASIS, so there was no need to collect data that is not already being collected. "Results of the study show that there were no significant increased costs or need for increased staff to participate in the P4P demonstration," says Buczko. The caveat of this result is that participating agencies volunteered for the demonstration, so there may be agencies who did not want to participate that might require more staff or incur higher costs to implement strategies that will produce cost-effective care and improved quality, he adds.

Although the demonstration ended in December 2009, it will take time to develop the final report, says Buczko. "In the next year, we will evaluate data from the second year and finalize the Year 2 payout, surveys of the agencies will take place, and we should have the evaluation of the demonstration finalized in around September 2011," he says.