Quality Preparing for payment changes

The upcoming year will likely bring big changes on the quality front as the CMS rolls out the next phases of its value-based purchasing program and other insurers step up their efforts to link payment to performance, experts say.

Finalized in April, the government’s valuebased purchasing program ties a portion of hospitals’ annual payment update for 2013 to performance on selected clinical process-of-care measures and patient-satisfaction scores.

Although the initial framework is in place, 2012 will be a critical year as the CMS introduces new requirements to the program and hospitals ramp up their reporting capabilities, says Stuart Guterman, vice president for payment and system reform at the New York-based Commonwealth Fund, and executive director of its Commission on a High Performance Health System.

“There’s still a lot of work that remains to be done,” Guterman says, referring to the valuebased purchasing program, as well as other recent changes, such as the final rules for accountable care organizations. “The next year or two will really involve taking these new ideas and putting them in place.”

Guterman also predicted that payers will increase their efforts to make connections between providers that are ahead of the curve on quality improvement and those who may still have a ways to go. “We are beyond thinking that one model will work for everyone, but there are elements there that all providers can use,” he says.

Some hospitals have been modeling the potential effects of value-based purchasing for some time, says Marianne Udow-phillips, director of the Ann Arbor, Mich.-based Center for Healthcare Research & Transformation, a notfor-profit partner of the University of Michigan. Other organizations with fewer resources are playing catch-up, she says.

The ever-increasing focus on quality will have other consequences, Udow-phillips says. VBP and ACOS will accelerate the integration trend among hospitals and physicians, she predicts. “It’s happening already, but I think those two initiatives will bring hospital staff even closer together as they focus on quality improvement.”

—Maureen Mckinney