MSPB in Home Health Has Arrived: Why Home Health Agencies Should Be Paying Attention

For many home health leaders, Medicare Spending per Beneficiary (MSPB) has been an overlooked quality measure. Although it has appeared on CMS Care Compare for years, 2026 marks the first year that MSPB directly impacts Home Health Value-Based Purchasing (HHVBP) payment adjustments, making it a financial as well as a quality metric.

Unlike traditional measures that focus on outcomes during the home health episode, MSPB evaluates the total Medicare spending associated with a patient's home health experience, including all Medicare Part A and Part B services provided during the home health stay and 30 days post discharge. Hospitalizations, emergency department visits, physician services, imaging, laboratory testing, and other downstream utilization all contribute to an agency's score. Lower Medicare spending relative to expected results in a better (lower) MSPB ratio.

Where MSPB Shows Up and Why it Matters?

• HHVBP payment adjustment: MSPB is 10% weight – this directly increases or decreases your agency’s Medicare reimbursement.

• Care Compare: Referral sources, patients, and hospitals are already looking at your agency’s cost efficiency on publicly available sites to help guide agency selection choices.

• Total Performance Score (TPS): MSPB joins other claims-based metrics, OASIS measure, and HHCAHPS to form your agency’s TPS, which directly impacts payment.

• Referral relationships: Hospitals and ACOs are increasingly choosing home health partners based on cost-efficiency data.

What Drives MSPB?

As CMS emphasizes value over volume, several patterns consistently emerge as the largest drivers of MSPB performance:

• Hospitalizations during the home health episode

• Emergency department visits (whether or not they result in admission)

• Hospitalizations within 30 days following home health discharge

• Discharge disposition trends and successful transitions back to community

These themes reinforce that MSPB is less about reducing services and more about providing the right care at the right time while preventing avoidable high-cost utilization.  Accurate OASIS coding is critical to appropriately reflect patient complexity and expected resource utilization.

As HHVBP increasingly rewards agencies that successfully manage patients across the continuum of care, reducing avoidable hospitalizations—both during the home health episode and in the critical 30 days following discharge—represents one of the greatest opportunities for Ohio agencies to improve both patient outcomes and financial performance.

Berg Data subscribers can benchmark their agency's MSPB performance alongside hospitalization rates, and additional value-based metrics.  To learn more about key trends in your community of service, contact Berg Data Solutions at: sarah@bergdatasolutions.com or marc@bergdatasolutions.com.