Hospital Value-Based Purchasing Update

Jim PoyerDirector, OCSQ/QIG/DQIPAC

April 27, 2011

Value-Based Purchasing and Linking Payment to Quality

Value-Based Purchasing is one important step in revamping how we pay for health care

Will reward better value, outcomes, and innovations instead of volume

Measures should be based on a mix of the following: – Standards

– Process measures

– Outcomes

– Patient experience measures Care Transitions and Changes in Patient Functional Status

Goal: quickly move to using primarily outcome and patient experience measures (using risk adjustment as appropriate)

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Introduction: Hospital Value-Based Purchasing (VBP) Program

Required by Congress under ACA section 3001 (adding new Social Security Act Section 1886(o))

Next step in promoting higher quality care for Medicare beneficiaries

CMS views value-based purchasing as an important driver in revamping how care and services are paid for, moving increasingly toward rewarding better value, outcomes, and innovations instead of volume

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Hospital Value-Based Purchasing (VBP) Proposed Measure Topics

FY 2013:

Process of Care Measures– Acute Myocardial Infarction (AMI)

– Heart Failure (HF)

– Pneumonia (PN)

– Surgical Care Improvement Project (SCIP)

– Healthcare Associated Infections (HAIs), as defined by the Secretary’s HAI Action Plan

Patient Experience of Care:

– Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey

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FY 2014:

Process of Care Measures: Use all 2013 Measures, plus add 1 SCIP Clinical Process Measure

Patient Experience of Care:

– Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey

NEW TOPICS

Outcome Measures:

– 30-day mortality measures: AMI, HF, and PN

– AHRQ Patient Safety Indicators and Inpatient Quality Indicators

– Hospital Acquired Conditions

Efficiency Measure:

– Medicare Spending per Beneficiary

How Will Hospitals Be Evaluated under the 2013 Hospital VBP Program?

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Proposed Summary for FY 2013 Program:– Two domains:

• Clinical Process of Care (12 measures)

• Patient Experience of Care (8 HCAHPS dimensions)

– Hospitals receive the higher of two scores (Achievement and Improvement) for each measure or dimension as applicable

– Individual measure scores summed to create Clinical Process of Care domain score

– 8 HCAHPS dimension scores summed with consistency points to create Patient Experience of Care domain score

– Total Performance Score based on:

• 70% weight for Clinical Process of Care domain

• 30% weight for Patient Experience of Care domain