Decoding the HHVBP Report: What Your Scores Really Mean

The healthcare landscape is shifting toward value-based care, and home health agencies (HHAs) are no exception. The Home Health Value-Based Purchasing (HHVBP) program is a major driver in this evolution, aiming to improve patient outcomes and reduce Medicare spending by financially rewarding (or penalizing) agencies based on performance metrics. With the national expansion of HHVBP beginning in 2023, understanding your HHVBP report isn’t just helpful—it’s essential for survival and growth.

But let’s be honest: the HHVBP report is not exactly light reading. It’s packed with acronyms, benchmarks, and percentile rankings that can easily overwhelm even seasoned professionals. So let’s break it down.

What is the HHVBP Program?

Launched by the Centers for Medicare & Medicaid Services (CMS), the HHVBP program aims to incentivize quality over quantity in home health care. Rather than being paid solely based on services rendered, HHAs are now evaluated on how effectively they deliver care.

Under this model, agencies are scored on a range of performance measures. These scores can lead to payment adjustments—positive or negative—that impact their Medicare reimbursement.

In 2025, payment adjustments will range from +5% to -5%, based on 2023 performance. This means that understanding your HHVBP report and actively managing performance metrics can directly impact your bottom line.

The Anatomy of the HHVBP Report

Your HHVBP report typically includes several key components:

• Achievement and Improvement Scores

• Quality Measures

• Total Performance Score (TPS)

• Linear Exchange Function

• Payment Adjustment

Let’s take a closer look at each.

1. Achievement and Improvement Scores

Each quality measure is scored in two ways:

• Achievement Score: This compares your agency’s performance to a national benchmark.

• Improvement Score: This evaluates how much your agency has improved compared to your own past performance.

CMS uses whichever score is higher—your achievement or your improvement—when calculating your Total Performance Score. This dual approach rewards both high performers and fast improvers.

Pro Tip: Don’t neglect your improvement metrics. Even if your baseline is low, you can earn a strong score through significant progress.

2. Quality Measures: What You’re Being Scored On

The quality measures in HHVBP fall into three broad categories:

A. OASIS-Based Measures

These are drawn from the Outcome and Assessment Information Set (OASIS) and include things like:

• Improvement in ambulation

• Improvement in self-care

• Improvement in dyspnea

B. Claims-Based Measures

These are based on Medicare claims data and include:

• Acute care hospitalization

• Emergency department use without hospitalization

C. HHCAHPS Survey-Based Measures

These reflect patient satisfaction and include:

• Communication with agency staff

• Care coordination

• Overall rating of the home health agency

Each of these contributes to your Total Performance Score (TPS), which ultimately affects your payment adjustment.

3. The Total Performance Score (TPS)

Your TPS is a weighted average of your best scores across the three categories. Each category has a different weight:

• OASIS Measures: 35%

• Claims Measures: 35%

• HHCAHPS: 30%

Once your measure scores are determined, they’re converted into a standardized scale (0–10 for each measure), and combined to calculate your final TPS.

A higher TPS means a higher payment adjustment. A lower score? You guessed it—your Medicare payments take a hit.

4. The Linear Exchange Function: Turning Scores into Dollars

Now, how does that TPS translate into actual money?

CMS uses what’s called the Linear Exchange Function to convert performance scores into payment adjustments. This function sets thresholds based on national performance and distributes the full range of payment adjustments (up to +5% or -5%) accordingly.

It’s called “linear” because there’s a straight-line relationship between TPS and payment adjustment—meaning every point counts.

5. Payment Adjustments: What’s at Stake?

Each year, HHAs receive a payment adjustment based on their TPS relative to other agencies. Here’s what’s at stake:

• Top Performers: Agencies in the upper percentiles receive up to a 5% bonus.

• Low Performers: Agencies with low scores can see a reduction of up to 5% in Medicare payments.

• Middle Ground: Agencies near the national average may see minimal adjustment, positive or negative.

This creates a high-stakes environment where continuous improvement is not optional—it’s vital.

How to Read and React to Your HHVBP Report

Step 1: Identify Your Baseline

Before you can improve, you need to know where you stand. Use your report to pinpoint:

• Low-performing quality measures

• Measures with high potential for improvement

• Trends across multiple reporting periods

Step 2: Analyze Performance Gaps

Don’t just look at the numbers—understand why certain metrics are low. Is it a clinical issue? A documentation problem? A workflow breakdown?

Step 3: Develop a Quality Improvement Plan

Target your efforts based on data. For example:

• Poor HHCAHPS scores? Train your staff on communication and empathy.

• High hospitalization rates? Focus on transitional care protocols.

• Weak OASIS outcomes? Audit your assessments and retrain staff where needed.

Step 4: Monitor Progress Regularly

Quality improvement is not a “set it and forget it” game. Use internal dashboards, mock surveys, and peer reviews to track your progress continuously.

HHVBP Report Myths—Debunked

Let’s clear up a few common misconceptions:

❌ “Only big agencies can do well.”

Truth: The improvement score levels the playing field. Small agencies that show major gains can outperform larger peers.

❌ “Patient satisfaction is subjective and doesn’t matter.”

Truth: HHCAHPS scores are 30% of your TPS. Soft skills like empathy and clarity in communication are crucial.

❌ “Once the report is out, it’s too late to change anything.”

Truth: While you can’t change past scores, you can learn from them to improve future performance and prepare for upcoming adjustment periods.

Tools to Help You Decode Your HHVBP Report

Here are some resources to make decoding easier:

• CMS HHVBP Technical Manuals: Deep dives into scoring methodology

• Your Medicare Administrative Contractor (MAC): For report clarification and support

• Data Analytics Tools: Many EMRs now include dashboards tailored for HHVBP tracking

• Third-Party Consultants: Can help with interpreting data and implementing quality improvement strategies

Final Thoughts: Turning Data into Dollars (and Better Outcomes)

The HHVBP report isn’t just a bureaucratic formality—it’s a roadmap. A high score leads to higher reimbursements and stronger positioning in a competitive market. A low score? That’s a call to action.

By understanding your scores and the mechanics behind them, your agency can turn data into dollars—and more importantly, into better care for your patients.

Stay proactive. Stay informed. And remember: every data point is an opportunity for improvement.