Cheers, qualms over value-based pur­chas­ing

Modern Healthcare - - SPECIAL REPORT -

The CMS un­veils its hos­pi­tal val­ue­based pur­chas­ing pro­gram, which re­wards hos­pi­tals for their per­for­mance on se­lected mea­sures. The pro­gram, first pro­posed in Jan­uary, draws praise for its fo­cus on qual­ity but also sparks protest among many providers, who worry about the weight given to pa­tient-sat­is­fac­tion scores and about penal­ties for hos­pi­tal-ac­quired in­fec­tions.

In July, three months af­ter the ini­tial rule is fi­nal­ized, the CMS is­sues additional pro­posed changes to the pro­gram for 2014, re­leased along with the agency’s pro­posed rule for out­pa­tient re­im­burse­ment. The agency’s ad­di­tion of an ef­fi­ciency mea­sure, which re­wards or pe­nal­izes hos­pi­tals based on their per-pa­tient Medi­care spend­ing, draws ire from provider groups, in­clud­ing the Amer­i­can Hos­pi­tal As­so­ci­a­tion, which ar­gues the mea­sure is not en­dorsed by the National Qual­ity Fo­rum.

In Novem­ber, the CMS re­sponds to provider com­ments, omit­ting hos­pi­ta­lac­quired con­di­tions from the pro­gram for 2014, and giv­ing hos­pi­tals more breath­ing room on the ef­fi­ciency mea­sure.

Other high­lights:

HHS re­leases its National Strat­egy for Qual­ity Im­prove­ment in Health Care, which pro­vides a broad frame­work to cut health­care costs, im­prove pop­u­la­tion health and pro­mote qual­ity. Ini­tial pri­or­i­ties in­clude en­gag­ing pa­tients and fam­i­lies, co­or­di­nat­ing care, and ad­dress­ing lead­ing causes of mor­tal­ity.

The na­tion’s level of over­all health­care qual­ity is up slightly— par­tic­u­larly in pre­ven­tive ser­vices and treat­ment of acute ill­nesses— but racial, eth­nic and so­cioe­co­nomic dis­par­i­ties per­sist, ac­cord­ing to the 2010 National Health­care Qual­ity and Dis­par­i­ties Re­ports, re­leased in March by HHS’ Agency for Health­care Re­search and Qual­ity.

HHS un­veils the Part­ner­ship for Pa­tients, a $1 bil­lion pub­lic-pri­vate ini­tia­tive aimed at re­duc­ing pre­ventable hos­pi­tal read­mis­sions and low­er­ing rates of hos­pi­tal-ac­quired con­di­tions. HHS pre­dicts the pro­gram will save as many as 60,000 lives over the next three years and as much as $50 mil­lion over the next decade.

Rates of cen­tral line-as­so­ci­ated blood­stream in­fec­tions have fallen 58%, from 43,000 in 2001 to 18,000 in 2009, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion says in a March re­port. The agency cred­its the drop to use of ev­i­dence-based prac­tices and im­proved sur­veil­lance.

A study pub­lished in the April is­sue of Health Af­fairs finds that the num­ber of ad­verse events in hos­pi­tals could be as many as 10 times higher than pre­vi­ous es­ti­ma­tions.

In the face of provider crit­i­cism, the CMS pub­lishes a file on its Hos­pi­tal Com­pare web­site con­tain­ing fa­cil­ity-spe­cific data on hos­pi­tal-ac­quired con­di­tions.

The NQF up­dates its list of se­ri­ous re­portable events for the first time in five years, adding four new events and ad­dress­ing pa­tient safety out­side of hos­pi­tal set­tings.

The National Com­mit­tee for Qual­ity As­sur­ance re­leases its an­nual State of Health Care Qual­ity 2011 Re­port, show­ing over­all im­prove­ments in qual­ity across health plans in ar­eas such as chronic dis­ease man­age­ment and pre­ventable hos­pi­tal read­mis­sions.

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