Moving in the right direction
Value-based purchasing changes meet approval
There’s a feeling that the CMS listened to concerns levied by hospital officials and healthcare consultants when the agency delivered its final rule on the hospital value-based purchasing program.
“We’ve been long a supporter of value-based programs, but we’re extremely happy in this regulation,” said Chip Kahn, president and CEO for the Federation of American Hospitals. “They recognized some of the issues that have been raised in the process, particularly regarding the efficiency and hospital-acquired conditions measure.”
Concerns grew out of the 12 clinical process-of-care measures to gauge hospital performance that the CMS incorporated into the April regulations carrying out the program as outlined in the Patient Protection and Affordable Care Act. The agency made revisions to the program in proposed regulations issued in July, which sent hospital advocates lobbying the CMS to adjust the requirements.
Last week’s final rule established measures that would determine the value-based incentive payments hospitals would receive in fiscal 2014. Changes included the addition of a process measure to guard against infection from urinary catheters, and more clearly defining a variety of items. They included re-evaluating how a hospital’s performance should be calculated, providing hospitals with more time to grow comfortable with measurements before they are used to affect payments and to determine how much of a patient’s experience should affect performance.
Many hospital officials worried that the CMS deadlines gave them little time to grow comfortable with the new measurements for Medicare costs per beneficiary. They also claimed by posting measurements for less than a year on the Hospital Compare website before using it for value-based purchasing, the CMS was contradicting the Affordable Care Act, which they argue requires the CMS to list measurements on Hospital Compare for at least a year, unless specified on the Hospital Inpatient Quality Reporting Program. The measurements in question were for hospital-acquired conditions and Agency for Healthcare Research and Quality composite measures.
The American Hospital Association argued that many of the measurements were new and that the seven-month per-
Percutaneous coronary intervention is one of the clinical process measures considered in Medicare’s value-based purchasing program.