Medicare home health agencies providing care in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee and Washington could be subject to value-based reimbursement beginning in 2018.

The idea, contained in a Centers for Medicare & Medicaid Services proposed rule, would call for home agencies to be subject to up to a 5 percent quality-linked gain or loss in 2018 (based on prior-year performance). The risk would climb in steps over time to 8 percent in 2021.

The move is designed to start the process of bringing home health agencies into federal health care reform efforts, with the nine states serving as a testing ground for the rest of the country. "People want to be taken care of in their homes and communities whenever possible, and CMS aims to make sure that care in the home is supported by a value-based care delivery model that is consistent with the rest of the system," said Andy Slavitt, acting administrator, in a news release.

CMS estimates that about 3.5 million beneficiaries receive home health care from about 11,850 home health agencies and at a total cost of $17.9 billion, according to a CMS fact sheet. Home health also has been tagged in a Health Affairs study as being the source of much of the geographic variation in Medicare spending.

Officials for the Home Care Alliance of Massachusetts are still studying the proposed rule for an evaluation of the proposals. "We'll certainly be commenting on it" to CMS said James Fuccione, director of legislative and public affairs for the alliance. Comments will be accepted by the agency until Sept. 4.

Fuccione noted that CMS has left open the possibility of making fairly big changes, such as shifting to a focus on cities instead of states.

Among the measures proposed for use in the pilot are four new to the Medicare home health program:

  • Advance care planning;
  • Adverse event for improper medication administration and/or side effects;
  • Influenza vaccination coverage for home health care personnel;
  • Shingles vaccination received by home health agency patients.

More broadly, the proposed rule states that many of the key elements of the home health care value-based model align with the Medicare hospital value-based purchasing program.