HHVBP 2025: Why “Good Enough” Isn’t Good Enough Anymore

I spend a lot of time talking with home health owners who are doing the right things—seeing patients quickly, documenting carefully, coaching staff. And yet this year, many are feeling blindsided by the first national payment year of Home Health Value-Based Purchasing (HHVBP).

Here’s the stat that crystallized it for me:

In CY2025, 54% of nonprofit home health agencies received a negative HHVBP payment adjustment.

That’s not a blog headline. That’s the reality of operating in a model where your Medicare FFS payments move up to ±5% on every claim based on how you performed against your peers—on measures that heavily weight preventable hospitalizations, discharge to community, timely starts, and patient experience.

If more than half of mission-driven nonprofits landed below zero, it tells us two things:

1. The bar moved, and

2. “Good enough” last year won’t be good enough next year.

What changed in 2025 (and why it feels different)

• It’s real money, now. 2025 is the first national payment year; adjustments apply to each Medicare FFS claim and are based on 2023 performance (with a two-year lag going forward).

• The bar rose in subtle ways. Example: the achievement threshold for Management of Oral Medications jumped—agencies now need ~85%+ before achievement points start accruing (larger-volume cohort). That’s a quiet but material shift.

• Hospital avoidance counts more. New weight goes to within-stay potentially preventable hospitalizations and discharge to community—exactly the outcomes that stress small teams, thin coverage, and long drive times.

Put simply: HHVBP now rewards agencies that can consistently start care on time, keep patients out of the hospital, and send them home safely—at scale.

What this means for everyday operations

When I walk workflows with owners, three pressure points tend to decide HHVBP outcomes:

1. Starts of Care (SOC) speed. If you’re not staffing and routing for a ≤48-hour SOC target on eligible patients, you’re fighting a headwind you can’t see.

2. Preventable hospitalization risk. CHF/COPD/wound patients need proactive monitoring and same-day escalation paths. The model weights these outcomes more heavily; a few bad weeks can shape your entire year.

3. Documentation and denials. HHVBP incentives stack on top of base rate pressures. Clean, timely documentation (with fewer avoidable denials) is the oxygen that funds more nursing hours on the road.

My playbook for owners (what I’d do in the next 90 days)

1) Make HHVBP visible—weekly.
Stand up a simple scorecard: SOC ≤48h rate, within-stay PPH, DTC-PAC, and patient experience. Post it where clinicians actually look. Don’t hide the ball—invite fixes from the team. (CMS publishes measure definitions; you can align your board to theirs.)

2) Staff to the first 72 hours.
Re-route so the first 2–3 visits are the easiest to schedule, not the first to slip. That’s when most deterioration risk and patient anxiety live—and where hospital avoidance starts.

3) Stand up a lightweight escalation ladder.
Nurse triage line (after hours), same-day PRN visit slots, and a “yellow flag” list pushed to the morning huddle. These small mechanics move PPH and experience scores more than any shiny tool.

4) Add just-enough tech.
At-home monitoring kits for CHF/COPD/wound cohorts and assistive AI for chart QA (not decision-making). The goal is fewer misses and faster documentation—not more clicks.

5) Train to the measure, not the myth.
Walk teams through how each HHVBP measure is earned. For example, explain why one missed SOC or one weekend admission without coverage can ripple across your monthly report.

A word on “stars,” HHVBP, and staying pragmatic

Care Compare star ratings and HHVBP aren’t the same thing—but they rhyme. In my experience, agencies consistently at or above 3 stars have the operational muscle to avoid a HHVBP downside year, while leaving room to climb into upside as processes mature. Treat 3-star as a floor to protect revenue, then build from there—because HHVBP upsides and downsides are only getting more consequential. (In HHVBP, the ±5% payment band is now in force and applied claim by claim.)

The mindset shift

HHVBP is not a marketing program. It’s a systems test of whether your agency can deliver fast, reliable, home-first care—week after week, across payer mixes and zip codes.

That’s why at Lydians we keep repeating the boring stuff: caregivers first, density over distance, simple playbooks, intentional integration. You can’t spreadsheet your way to better hospital avoidance. You have to route it, staff it, train it, and measure it—and then make tomorrow’s routes a little tighter than today’s.

If you’re an owner wrestling with HHVBP (or trying to get ahead of next year’s two-year lag), I’m happy to compare notes. Whether you sell now, later, or never, the agencies that operate to the measures—and keep the work humane for teams—will win this decade.

Citations & resources

• CMS HHVBP Expanded Model page; first payment year 2025; ±5% adjustment applied to each Medicare FFS claim; performance year–payment year lag.

• CMS HHVBP 2025 measure set & weights (PPH, DTC-PAC, function, etc.).

• Thresholds tightening example (achievement threshold ≈85.18% for Oral Meds in 2025, larger-volume cohort).

• LeadingAge analysis: 54% of nonprofit HHAs received a negative HHVBP adjustment in CY2025.

• 2025 rate environment context and operational impacts.