The Home Health Value-Based Purchasing (HHVBP) model is undergoing significant changes in 2025, and the introduction of new measures based on GG functional assessment items is a key part of these updates. These changes will have a substantial impact on home health agencies and how they approach HHVBP performance.
The GG items, which were introduced in 2019, are part of the Standardized Patient Assessment Data Elements (SPADEs) and are designed to align quality measurement across post-acute care settings. Unlike the more general G items, the GG items provide more specific guidance on assessing a patient’s functional abilities and goals in areas like self-care and mobility.
Replacement of Existing Measures
The HHVBP model is replacing several existing measures with new ones that utilize GG items instead of the traditional M1800 series. Specifically:
- The “Discharge to Community” measure, which was based on OASIS data, is being replaced by a “Discharge to Community Post-Acute Care” measure that uses claims data.
- The Total Normalized Composite Change in Mobility and Change in Self-Care measures are being consolidated into a single Discharge Function Score that relies on GG items rather than M1800 items.
Importance of the Discharge Function Score
The new Discharge Function Score, which accounts for 20% of an agency’s Total Performance Score in HHVBP, is a critical measure that home health providers must focus on. This score is determined by comparing the patient’s actual discharge GG item responses to an estimated discharge function score generated from the initial assessment.
To excel on this measure, agencies must ensure their clinicians are thoroughly trained on accurately completing the GG section of the OASIS. Quality assurance processes to review GG item responses will also be essential. Agencies that do not prioritize GG item accuracy risk lower Discharge Function Scores and reduced HHVBP payments.
Impact on PDGM and Home Health Compare
The GG items remain a key component of the Patient-Driven Groupings Model (PDGM) and are used in Home Health Compare quality reporting. Agencies must therefore maintain a comprehensive focus on accurate OASIS data collection, including both the M1800 series and the GG items, to succeed across all payment and quality initiatives, not just HHVBP.
As a revenue cycle management company serving the home health industry, HealthRev Partners understands the critical importance of accurate OASIS coding and documentation. With significant changes on the horizon in 2025, it’s essential that home health agencies start preparing now to ensure a smooth transition.
Impact on Value-Based Purchasing and PDGM
GG items have significant implications for home health agencies:
- Value-Based Purchasing (VBP): In the VBP model, the current Total Normalized Composite (TNC) scores for self-care and mobility will be replaced by a single Discharge Function Score based solely on the GG items. This Discharge Function Score will account for 20% of an agency’s Total Performance Score.
- PDGM: While the GG items do not directly impact PDGM reimbursement, accurate coding of these items is crucial. Incorrect OASIS-E scores, including the GG items, can negatively affect compliance and reimbursement for home health agencies.
Preparing for 2025
To adequately prepare, home health agencies should take the following steps:
1. Educate Staff:
Ensure that all clinicians responsible for completing the OASIS, including new hires, receive comprehensive training on the differences between the G and GG items, as well as the proper coding and scoring guidance. Consider utilizing a Preceptor Partnership to enhance clinical performance and documentation practices.
- Emphasize the importance of understanding the inclusions, exclusions, and coding scale differences between the M-items and GG items.
- Address the issue of overusing the “activity not assessed” (ANA) codes for the GG items, as CMS will be imputing scores based on patient characteristics.
2. Review Processes:
Evaluate your current OASIS review processes to identify any gaps or areas for improvement. Implement quality assurance measures to catch and correct errors in GG item coding.
- Ensure your agency’s coding and OASIS review partners and processes are data-driven and focused on building performance.
3. Analyze Performance:
Closely monitor your agency’s performance on the GG items, both at the start of care and discharge. Use this data to identify opportunities for improvement and target areas for staff education.
4. Stay Informed:
Keep up-to-date on any further guidance or changes from CMS regarding the transition from G to GG items.
- Keep up-to-date on any further guidance or changes from CMS regarding the transition from G to GG items. Subscribe to CMS newsletters and participate in relevant webinars or training opportunities.
- Leverage the support of your electronic health record (EHR) vendor in the implementation of OASIS-E and the timing of the updates.
- Use the remainder of 2024 as a ramp-up period to improve the accuracy of responding to the GG items in preparation for the January 1, 2025 implementation.
Support Through the Transition
Home health agencies can ensure accurate OASIS documentation, maintain compliance, and optimize reimbursement under the VBP model and PDGM. As a revenue cycle management partner, we are here to support you through this transition and help your agency navigate home health quality reporting and reimbursement.
