HM12 Pre-course Analysis: How to Improve Performance in CMS Valued Based Purchasing Program

As part of the Affordable Care Act, the value-based purchasing program (VBP) is being rolled out this year. Beginning in October, VBP will put hospitals at financial risk for a defined set of clinical and patient satisfaction metrics. Because of the significant impact that this will have on hospitals and HM, SHM had a pre-course focused on this topic at HM12.

Pat Torscon and Joe Miller led the pre-course, which focused on VBP’s key components. Through a series of vignettes and studies, the faculty provided nearly 100 attendess a better understanding of the impact.

Key Takeaways

1. VBP is budget neutral. Some Hospitals will receive bonuses, some will not. This will depend on where hospitals fall in the performance score. To receive a bonus, a hospital will have to exceed the 50% threshold. If below, then no opportunity for performance bonus. The model is based on a floor, a threshold (50%), and benchmark, which is presently a bell-shaped curve.

2. The performance score will be 70% clinical process domain and 30% patient experience domain. Hospitalists will have a major role in the perfromance measures around AMI, CHF, pneumonia, SCIP, and patient experience.

3. Hospitalists will need to understand the data and where it comes from. When you combine VBP, Inpatient Quality Reporting, readmissions, hospital-acquired conditions, and meaningful use, the actual amount of payment at risk is 7%. With most hospital profit margins around 1-3% this amount will be significant. Of those hospitals that have been studied, 10% in high performance, and 74% were inconsistent performance across four clinical measures.

4. Concurrent patient management will be important. Hospitalists will become the drivers and champions of this. To move either your HCAHPS score or Press Ganey performance scores will take time. It is important to convey that to the C-suite. An example of the impact of VBP for a 146-bed hospital over five years could be more than $5 million at stake; a 541-bed hospital would be $40 million.

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