CMS: It’s Quality Over Quantity with Value-Based Purchasing
By - The ever familiar “Show me the money!” mentality only rings true in the case of quality over quantity regarding hospital payments, implies the Centers for Medicare & Medicaid Services (CMS).
The Hospital Value-Based Purchasing (VBP) Program – a Medicare-implemented Affordable Care Act (ACA) program aimed at advancing value over volume – regulates specific financial amounts hospitals are paid by CMS via the Inpatient Prospective Payment System (IPPS). Such payments are administered according to degrees of care quality, says CMS within this week's released fact sheet regarding Fiscal Year 2016's Results for CMS's Hospital VBP Program.
The VBP Program provides information about how well hospitals are faring regarding the patient care realm. “The Hospital VBP Program is part of our long-standing effort to structure Medicare payments to improve healthcare quality, including hospital inpatient care,” states CMS.
Law will soon mandate an increase in Medicare payments funding the program’s value-based incentive payments for all participating hospitals from 1.5 percent to 1.75 percent of the base operating Medicare Severity diagnosis-related group (MS-DRG) payment amounts.
Hospitals excluded from the VBP Program will not incur this 1.75 reduction, nor are they eligible for other incentives, CMS maintains.
CMS: we now pay based on quality, not quantity
Says CMS, "We now pay hospitals for inpatient acute care services based on the quality of care, not just the quantity of services provided.”
CMS predicts fiscal year 2016’s total available amount available for value-based incentive payments will near $1.5 billion. CMS confirms it is actively working to advance how performance is evaluated by incorporating a “richer” measure set and maintaining parallels with the National Quality Strategy (NQS).
According to CMS, fiscal year 2016’s four quality domains were as follows:
- 10 percent: Clinical process of care
- 25 percent: Patient experience of care (HCAHPS survey)
- 40 percent: Outcome (hospital mortality measures for acute myocardial infarction, heart failure, and pneumonia, the central line-associated bloodstream infection measure, the catheter associated urinary tract infection measure, the surgical site infection strata, and the AHRQ PSI-90 Composite)
- 25 percent: Efficiency (Medicare Spending per Beneficiary measure)
Hospitals will be paid “more or less” for each 2016 Medicare fee-for-service discharge than if such a program did not exist, says CMS. Payments will depend both upon the magnitude of improvements and how such stacks up against counterparts in regard to “important” health-care quality measures, CMS confirms.
CMS maintains hospitals merely want to offer better quality care and benefit patients in turn. “As we more closely link patient outcomes and treatment costs to value-based hospital payment, it's important to remember that the Hospital VBP program not only aims for quality gains on paper, it also aims to promote a culture focused on the needs of patients,” states CMS.
“Value-based purchasing in Medicare continues to move ahead, improving health care for people with Medicare now and creating a health care system that will ensure quality care for generations to come,” the organization adds.
As RevCycleIntelligence.com reported, nearly 3,500 hospitals anticipate affected payments for inpatient stays. According to the Department of Health and Human Services (HHS), the VBP effectively aligns with HHS’s goal to execute an 85 percent transition of traditional Medicare payments to quality-based by next year and a 90 percent transition within the next 3 years.
