Mov­ing in the right di­rec­tion

Value-based pur­chas­ing changes meet ap­proval

Modern Healthcare - - THE WEEK IN HEALTHCARE - Ashok Selvam

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.

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