Earlier this year, the Centers for Medicare and Medicaid Services released a 34-page document that sought to answer questions about the dominant themes surrounding the federal organization's Hospital Value-Based Purchasing program, which starts shelling out incentive payments for top-performing facilities on October 1, 2012.
Important topics include hospital eligibility, information about incentive payments, performance periods, performance assessment, measures and scores, public reporting, and a host of others. Here, we provide you with a look at the top 10 questions that span a range of the above-mentioned categories.
[Ed Note: Learn more about best practices in hospital value-based purchasing during the webinar: Boosting Quality Process Measures: Steps to Success for Your Hospital on July 25.]Program Background
1. When will Medicare start paying hospitals based on the quality of care they provide?
Hospitals participating in the Hospital Value-Based Purchasing Program will begin to receive incentive payments for providing high quality care or improving care after October 1, 2012, the start of Fiscal Year 2013. The incentive payments will be based on a hospital’s performance during the period from July 1, 2011, to March 31, 2012.
Hospital Eligibility
2. What hospitals are participating in the Hospital Value-Based Purchasing Program?
More than 3,000 hospitals across the country are eligible to participate in Hospital VBP. The program applies to subsection (d) hospitals located in the 50 states and the District of Columbia and acute-care hospitals in Maryland. Hospital VBP is based on data collected through the Hospital Inpatient Quality Reporting (IQR) Program. More details about the Hospital IQR program are online at https://www.cms.gov/HospitalQualityInits/08_HospitalRHQDAPU.asp.
The following hospitals are excluded from Hospital VBP:
+Hospitals and hospital units excluded from the Inpatient Prospective Payment System, such as psychiatric, rehabilitation, long-term care, children’s, and cancer hospitals;
+Hospitals that do not participate in Hospital IQR during the Hospital VBP performance period;
+Hospitals cited by the Secretary of HHS for deficiencies during the performance period that pose an immediate jeopardy to patients’ health or safety; and
+Hospitals that do not meet the minimum number of cases, measures, or surveys required by Hospital VBP.
3. If we do not have enough cases for inclusion in clinical measures, are we dropped from entire VBP Program or will our percent still apply via HCAHPS?
In order to receive a Total Performance Score for the FY 2013 Program, hospitals must have sufficient data in both the Clinical Process of Care and Patient Experience of Care domains. If your facility does not have sufficient Clinical Process of Care data but has sufficient HCAHPS data, your hospital will be excluded from the FY 2013 Program.
Incentive Payments
4. What level of incentive payment can hospitals expect to receive through the Hospital Value-Based Purchasing Program?
Taking into account the reduction in base Diagnosis-Related Group operating payments to hospitals (1 percent for Fiscal Year 2013), CMS estimates that roughly half of participating hospitals will receive a net increase in payments as a result of this rule, while the rest will receive a net decrease in payments. CMS estimates that no participating hospital will receive more than a net 1-percent decrease in payments in FY 2013. Possible increases depend on the distribution of hospitals’ performance scores.
5. Is there a tool or program my hospital can use to identify the dollars at risk by Hospital VBP measurement?
Hospitals will be at risk for 1.0% of base operating Diagnosis-related Group (DRG) amounts for the FY 2013 Program. As required by the statute, that percentage will rise to 2.0% by FY 2017. CMS does not offer or recommend a specific tool; however, there may be several tools and resources available that will give hospitals an estimate of their performance for FY 2013.
6. How can facilities best prepare so that they do not experience negative financial impacts when payment adjustments begin under the FY 13 Hospital VBP?
Eligible hospitals should review their hospital's Simulated Report for at least two critical areas:
1. Strengths and weakness in the scoring domains to narrow down areas for improvement; also, the number of cases you might need to receive a score in another measure for the Clinical Process of Care Domain.
2. Impact of the Hospital VBP Program on Medicare DRG reimbursement for FY 2013.
Performance Periods
7. Please explain why Hospital Compare publishes four quarters of data while the baseline and measurement periods for Hospital VBP represent just three quarters of data.
Although CMS would have preferred to use a full year as the performance period for Fiscal Year 2013, CMS concluded that this would not provide sufficient time to calculate the Total Performance Scores and value-based incentive payments, notify hospitals regarding their payment adjustments, and implement the payment adjustments. Therefore, for FY 2013, CMS is finalizing the performance period described above as a three-quarter performance period, from July 1, 2011 to March 31, 2012.
Performance Assessment
8. What is the fundamental methodology behind the Hospital Value-Based Purchasing Program?
CMS will assess each hospital’s total performance by comparing its achievement and improvement scores for each applicable Hospital VBP measure and awarding the higher score for each measure. CMS will then aggregate each hospital’s scores into the appropriate domain.
The Fiscal Year (FY) 2013 Hospital VBP Program consists of two domains: 1) Clinical Process of Care and 2) Patient Experience of Care. The Clinical Process of Care score is simply the sum of measure scores in that domain. The Patient Experience of Care score is the sum of a hospital’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) base score and that hospital’s HCAHPS Consistency score. (Question 39 provides more detail about how the two domains will make up the total performance score.)
CMS will then multiply each domain score by domain-specific weights. For FY 2013, these weighted values are 70 percent for Clinical Process of Care and 30 percent for Patient Experience of Care. After each domain score is multiplied by its percentage value, CMS will add the weighted domain scores to reach a hospital’s Total Performance Score.
Each hospital’s Total Performance Score will be converted into a value-based incentive payment adjustment percentage using a mathematical formula. In FY 2013, CMS will use a specific formula that translates hospitals’ scores into incentive payment adjustment percentages by ranking all hospitals based on their scores. CMS will ensure that the total incentive payments do not exceed the total amount estimated to be withheld in FY 2013 under Social Security Act Section 1886(o)(7)(B).
Performance Measures
9. What quality measures will be used to evaluate hospitals for the Hospital Value-Based Purchasing Program?
CMS has adopted 13 of 45 quality measures tracked in the Hospital Inpatient Quality Reporting Program for the Fiscal Year (FY) 2013 Hospital VBP Program. The FY 2013 measures are provided
in the table on the next page.
For FY 2014, CMS also adopted the following measures into the Outcome domain:
+Three mortality outcomes measures, covering acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN).
Public Reporting
10. What hospital performance information gathered through the Hospital Value-Based Purchasing Program will be made available to the public?
The following information about a hospital’s performance determined through Hospital VBP will be made available to the public:
1. The hospital’s performance on each measure that applies.
2. The hospital’s performance with respect to each condition or procedure.
3. The hospital’s total performance score.
Information collectively describing all hospitals participating in the Hospital VBP Program will be posted periodically on the Hospital Compare website, including:
1. The number of hospitals receiving value-based incentive payments under the program, as well as the range and amount of these value-based incentive payments.
2. The number of hospitals receiving less than the maximum value-based incentive payment available for that fiscal year and the range and amount of these payments.
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