Total Performance Score (TPS)

For each measure in the applicable measure set, CMS compares the agency's performance-year result against two reference points from the baseline period: the achievement threshold (the median of the agency's cohort) and the benchmark (the mean of the top decile). Performance at or above the benchmark earns maximum achievement points; performance between the threshold and benchmark earns partial points. CMS also calculates improvement points against the agency's own baseline, and the agency receives the higher of achievement or improvement points for each measure. Improvement points cap slightly below the achievement maximum, so improvement alone cannot match sustained top performance. Weighted measure points are then normalized into the 0 to 100 TPS.

For the CY2026 performance year, the TPS is weighted 40% OASIS-based measures (including new bathing and dressing function measures), 40% claims-based measures (including the new Medicare Spending Per Beneficiary Post-Acute Care measure), and 20% HHCAHPS. Only two HHCAHPS measures remain, Overall Rating of Care and Willingness to Recommend, at 10% each. When an agency lacks sufficient data on a measure, that measure's weight is redistributed across the measures the agency can be scored on. That redistribution matters: an agency exempt from HHCAHPS, for example, will see its OASIS and claims performance count for even more.

CMS converts each agency's TPS into a payment adjustment using a linear exchange function applied within the agency's volume cohort. The model is budget neutral, so penalties on lower-scoring agencies fund bonuses for higher-scoring ones. An agency's adjustment depends not just on its own score but on how the whole cohort performs, which is why static performance can still produce a declining adjustment if peers improve faster. The resulting percentage, capped at plus or minus 5%, is applied to the agency's Medicare fee-for-service home health payments two years after the performance year.

Waiting for the annual results guarantees you are managing history. Instead:

• Pull Interim Performance Reports from iQIES each quarter and trend every measure
• Identify the two or three measures where you sit between threshold and benchmark, where point gains are cheapest
• Assign a named owner and a specific workflow change to each target measure
• Watch claims-based measures early, since their reporting lag hides problems longest