HHVBP 2026: Medicare Spending Per Beneficiary (MSPB)

Beginning in 2026, CMS is taking Home Health Value-Based Purchasing (HHVBP) one step further.

For the first time, the cost of care will directly impact reimbursement through the addition of the Medicare Spending Per Beneficiary (MSPB) measure.

This change was outlined in the CY 2026 Home Health Prospective Payment System (HH PPS) Proposed Rule—and it signals something very important:

High quality is no longer enough. It must also be cost-efficient.

What Is MSPB in Home Health?

The claims-based Medicare Spending Per Beneficiary (MSPB) measure was added to the Home Health Quality Reporting Program back in 2017. Until now, however, it was not tied to payment.

Starting in 2026, under HHVBP, that changes.

CMS states:

“Explicit measurement of costs of care will allow recognition of agencies that provide high-quality care at a lower cost.”

In other words, agencies that manage total Medicare spend effectively—while maintaining quality outcomes—will be rewarded.

If you are not already monitoring this measure on Care Compare, now is the time.

Here is how the measures are weighted under the 2026 proposal:

OASIS-Based Measures

• Improvement in dyspnea – 7%
   
• Improvement in management of oral medications – 11%
   
• Discharge Function Score – 15%
   
• Improvement in bathing – 3.5%
   
• Improvement in upper body dressing – 1.75%
   
• Improvement in lower body dressing – 1.75%
   

Claims-Based Measures

• Within-stay potentially preventable hospitalization – 15%
   
• Discharge to community – 15%
   
• Medicare Spending Per Beneficiary (NEW to payment) – 10%
   

HHCAHPS Measures

• Overall agency rating – 10%
   
• Willingness to recommend – 10%
   

The addition of MSPB at 10% is significant. It places cost management alongside functional improvement, hospitalization prevention, and patient satisfaction.

How MSPB Is Calculated

The final agency score uses two years of data and includes:

• Medicare spending for most Part A and Part B services during the home health episode
   
• Spending up to 30 days after discharge
   

Step 1: Compare Actual vs. Expected Cost

If the actual episode spending is $1,000, but the risk-adjusted predicted cost was $900:

1,000÷900=1.11,000 ÷ 900 = 1.11,000÷900=1.1 

Step 2: Average Across Episodes

If four episode ratios are:

• 1.1
   
• 0.8
   
• 1.3
   
• 1.2
   

The average = 1.1

Step 3: Multiply by National Average Spending

If the national average spending is $5,000:

5,000×1.1=5,5005,000 × 1.1 = 5,5005,000×1.1=5,500 

Step 4: Compare to National Median

If the national median MSPB is $4,000:

5,500÷4,000=1.3755,500 ÷ 4,000 = 1.3755,500÷4,000=1.375 

Final MSPB Score = 1.375

How MSPB Appears on Care Compare

Care Compare presents it simply:

“How much Medicare spends on an episode of care at this agency compared to Medicare spending across all agencies nationally.”

• A score of 1.00 = National average
   
• Above 1.00 = Higher-than-average Medicare spending
   
• Below 1.00 = Lower-than-average Medicare spending
   

In our example, 1.375 signals spending significantly above the national median.

This is publicly reported.

What’s Included in the 30-Day Post-Discharge Window?

MSPB includes costs during:

• Hospitalizations
   
• Outpatient visits
   
• Other Part A and Part B services
   
• The 30 days after home health discharge
   

This makes post-discharge monitoring essential.

If your patient is rehospitalized on day 12 after discharge, it impacts your MSPB score.

Risk Adjustment Variables

CMS adjusts for numerous factors, including:

• Dozens of diagnosis codes (HIV/AIDS, lung cancer, diabetes, CHF, coma, etc.)
   
• Patient indicators (ESRD, hospice status)
   
• Selected interactions (e.g., disability + substance dependence)
   
• Age (five-year increments)
   
• Clinical case mix category
   
• Prior home health admission
   
• ICU stays and prior hospitalization length of stay
   

This is not a raw cost comparison, but agencies must still actively manage utilization.

What Agencies Should Be Doing Now

Angela Huff of Forvis Mazars advises:

“If this is not something that an agency has been monitoring, providers need to go look at their scores on Care Compare and start working with their financial teams or advisors to put in place methods to measure, monitor and improve.”

From a compliance and operational standpoint, agencies should:

1️⃣ Monitor Care Compare Quarterly

Know your current MSPB ratio.

2️⃣ Strengthen Transitional Care

• Post-discharge calls
   
• Medication reconciliation follow-up
   
• Early symptom escalation protocols
   

3️⃣ Reduce Avoidable Utilization

• Proactive CHF/COPD pathways
   
• Early physician communication
   
• Stronger disease-specific education
   

4️⃣ Align Clinical & Financial Teams

MSPB cannot be managed solely by clinical leadership. Finance, QA, and operations must collaborate.

The Bigger Picture

HHVBP is no longer focused only on outcomes and satisfaction.

CMS is signaling a system-wide shift:

Quality + Cost Efficiency = Value

For agencies that already prioritize audit-proof documentation, proactive care management, and strong transitional processes, this is an opportunity.

For agencies that have not been monitoring total Medicare spend tied to their episodes, it is time to start.

Final Thought

The addition of MSPB to HHVBP reimbursement is not just another metric.

It is a clear message from CMS:

If you deliver high-quality care at a lower cost, you will be recognized.

If you don’t measure cost, you can’t manage it.

And in 2026, you will be paid based on it.

If your agency needs help analyzing MSPB trends, aligning clinical workflows, or building a monitoring framework before 2026 implementation, now is the time to act.