WHERE $850 MILLION WILL COME FROM
Medicare system will reimburse hospitals based on quality, safety and satisfaction measures
The CMS stuck to its guns as it launched value-based purchasing for hospital services.
In a final rule issued April 29, the agency refused to budge on several components of the program—including the weighting of patient experience-of-care measures and the inclusion of hospital-acquired conditions—that had rankled providers and industry groups when the proposed rule was released in January (Jan. 17, p. 6).
“We are disappointed that CMS essentially ignored comments from the field on the proposed Medicare value-based purchasing rule and did not adjust its policies accordingly,” said Blair Childs, senior vice president of public affairs for the group-purchasing and quality-improvement organization Premier, in a written statement.
The program is budget-neutral and the $850 million that will be available for hospital incentive payments during the program’s first year will come from an across-the-board 1% reduction in hospitals’ base operating DRG payments. That number will jump to 2% in 2017, HHS said.
Some providers and groups praised the program, which marks a dramatic shift from the current inpatient prospective payment system and the Hospital Inpatient Quality Reporting Program, which rewards hospitals for reporting quality data.
“Today’s payment system is riddled with perverse incentives that reward high volume and high profit-margin services, regardless of value, outcomes or appropriateness,” said Christine Bechtel, vice president of the National Partnership for Women & Families. Bechtel spoke at an HHS news briefing on behalf of the Campaign for Better Care, an
“Our biggest concern continues to be the inclusion of hospitalacquired conditions.”
—Beth Feldpush, American Hospital Association
advocacy organization that emphasizes healthcare quality and accessibility.
“This rule is a much needed effort to begin attacking this problem at its root,” Bechtel said.
Dr. Charles O’Brien, president of 478-bed Sanford University of South Dakota Medical Center, Sioux Falls, said his hospital is familiar with the program’s measures and he does not anticipate a problem complying. “We don’t have many worries, since we’ve been working on the core elements of these for some time,” O’Brien said.
The value-based purchasing program, which is mandated by the Patient Protection and Affordable Care Act, sets up a framework to reward hospitals for their performance on selected quality measures. To determine payments for 2013, the CMS will monitor hospitals during a performance period that runs from July 1, 2011, through March 31, 2012.
Based on scores calculated during the ninemonth performance period, hospitals will begin to receive incentive payments for discharges occurring on or after October 1, 2012. The CMS said it will notify hospitals of their estimated incentive payment for 2013 at least 60 days prior to that date.
For 2013, the CMS plans to measure hospitals using 12 clinical process-of-care measures, in areas such as surgical care, pneumonia care and prevention of healthcare-associated infec- tions. That’s five fewer measures than the agency originally included in the proposed rule, leaving out aspirin at discharge for heart attack patients, pneumococcal vaccination for pneumonia care and several others that the agency deemed “topped out,” meaning the majority of hospitals had reached a high level of performance on them.
The healthcare reform law requires that any measure that is used for value-based purchasing must have appeared on Hospital Compare, the CMS’ consumer quality information website, for at least one year.
In addition, the agency will measure hospitals’ patient experience scores, using the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Those HCAHPS scores, which measure patients’ impressions of hospital cleanliness, communication with clinicians and other factors, will be given a weight of 30% in the final scoring. The clinical process-of-care measures will be given the remaining weight of 70%.
That weighting ratio is identical to the one the CMS included in its proposed rule, and for many industry groups the agency’s refusal to lower the weight given to the HCAHPS measures is a big problem.
“We remain concerned with CMS’ decision to weight the patient experiences of care survey data at 30% of hospitals’ total scores,” the American Hospital Association said in a statement. “We believe the HCAHPS methodology should be refined to ensure that no hospital is systematically biased against performing well on these measures. Until that refinement occurs, the HCAHPS measures should receive less weight.”
According to Joanna Kim, the AHA’s senior associate director for policy, the worry is that certain healthcare organizations, such as academic medical centers, might be at a disadvantage when it comes to patient experience scores simply because of the patient populations they serve.
Chip Kahn, president and CEO of the Federation of American Hospitals, lauded the program as something “solid and needed,” but he also expressed concern about the weight given to HCAHPS scores.
“Regional differences are one of the reasons we felt so strongly that the thrust of the program needed to be about clinical care as