Evaluation of Home Health Pay for Performance Demonstration

The Home Health Pay for Performance (HHP4P) demonstration is part of a CMS initiative to improve the quality of care furnished to all Medicare beneficiaries receiving care from home health agencies (HHAs). This demonstration aims to test the "pay for performance" concept in the HHA setting. Under this demonstration, CMS provides financial incentives to participating HHAs that meet certain standards for providing high quality care. Participation of HHAs in this demonstration is voluntary. CMS will assess the performance of participating HHAs based on selected measures of quality of care, then make payment awards to those HHAs that either achieve a high level of performance or show exceptional improvement based on those measures. The quality measures include acute care hospitalizations, use of emergent care, as well as outcome measures from the Outcome and Assessment Information Set (OASIS). This demonstration has selected 4 states/state groups, one from each region of the U.S.: MA, CT (East), IL (Midwest), CA (West) and GA, AL, TN (South). Within each state/state group, HHAs which elected to participate were randomly assigned to treatment and control groups. The demonstration includes all Medicare beneficiaries that are treated by a participating HHA. Some beneficiaries in the demonstration are also eligible for Medicaid.