Home Health VBP: Potentially Preventable Hospitalization

Home Health VBP: Potentially Preventable Hospitalization

In Home Health Value Based Purchasing (HHVBP), the new Potentially Preventable Hospitalization (PPH) measure, introduced in 2025, aims to assess and reduce preventable hospitalizations and observation stays during a patient’s stay in home health care, replacing the previous Acute Care Hospitalization (ACH) and Emergency Department (ED) Use measures. This measure alone is 26% of the total score for Home Health Value Based Purchasing (HHVBP), making it critical for agencies to ensure that they are taking measures to prevent unplanned hospitalization.

The goal of the Potentially Preventable Hospitalization measure is to evaluate and reduce potentially preventable hospitalizations and observation stays that occur while patients are receiving home health care. The PPH measure also assesses the number of patients who, after being discharged from Home Health, do not require hospitalization or do not pass away within 31 days of their return to the community, making proper discharge planning crucial. Scheduled or planned hospitalizations are not included in this measure.

Home health agencies should be taking steps to identify and address factors that are contributing to potentially preventable hospitalizations within their agency in an effort to improve quality of care and optimal reimbursement. This measure helps CMS to ensure that agencies are focused on and committed to preventing unnecessary hospitalization.

How Can your Agency Reduce Preventable Hospitalization?

• Understand who is at Risk:
  • Agencies should begin screening patients for risk for hospitalization at the time the referral is received. Intake staff must be trained to identify high risk patients and communicate this risk to the agency Clinical Manager and field clinicians.
  • Upon Start of Care clinicians must be trained to identify all high-risk factors for hospitalization and ensure proper measures are taken when care planning such as front-loading visits and ensuring proper MD follow-up visits are scheduled.
  • Agencies should set aside time at the case conference to discuss new admissions who are at high risk for hospitalization and properly communicate and collaborate with the care team.
• Implement Proper Audits:
  • Hospitalization audits are a must for agencies to successfully meet the Potentially Preventable Hospitalization Measure.
  • The hospitalization audit process established should help agencies identify high risk disease processes that are contributing within their agency, opportunities for staff education and specific patients with hospitalization patterns in which additional care planning or visit frequency changes are required.

Agencies must ensure that they are not attempting to meet or successfully meet this measure blindly. With the measure at 26% of the total VBP scoring agencies must take this measure seriously and take action to identify all risk within the agency.

Contact Proactive for assistance successfully navigating the Potentially Preventable Hospitalization measure and to ensure you have the proper processes and tools in place—including auditing and monitoring programs.

Contact Proactive to learn more about Five-Star Improvement support services and develop a road map to Five-Star success in 2025.