The federal government is moving toward offering monetary rewards for reporting on specific performance indicators. When hospitals begin to seek those rewards, hospitalists will be integrally involved.
The Centers for Medicare and Medicaid Services (CMS) has been tasked with developing an approach to value-based purchasing (VBP) for Medicare hospital services beginning in fiscal year 2009. Once the proposal is complete and approved by Congress, hospitals will receive differential payments tied to their performance.
VBP is similar to pay for performance (P4P) in that it links a bonus payment to reporting on performance of specific procedures. But the payment in this case is awarded to a hospital rather than a physician. The goals for the CMS proposal include:
- Improve clinical quality;
- Address underuse, overuse, and misuse of services;
- Encourage patient-centered care;
- Reduce adverse events and improve patient safety;
- Avoid unnecessary costs;
- Stimulate investments in structural components and the re-engineering of care processes;
- Make performance results transparent to and usable by consumers; and
- Avoid creating additional disparities in healthcare and work to reduce existing disparities.
CMS has hosted two listening sessions on the VBP program, during which healthcare providers were able to directly offer suggestions and opinions. The latest information, including an options paper based on the first listening session, is available online at www.cms.hhs.gov/center/hospital.asp.
“I was impressed with their responsiveness to the feedback they received at two listening sessions,” says Gregory B. Seymann, MD, associate clinical professor, University of California, San Diego School of Medicine, Division of Hospital Medicine, and a member of SHM’s Public Policy Committee. “I can see that the second options paper incorporates a lot of the comments from the first session.”
SHM has expressed support for CMS’ VBP proposal in a letter to the agency that also urged CMS to select candidate measures for hospitals that align with those for individual physicians under the Physician Quality Reporting Initiative (PQRI), which started July 1.
“These are very similar programs; one rewards hospitals for performing certain processes of care, and one rewards physicians for performing certain processes,” Dr. Seymann explains. “We’re simply asking CMS to make sure the measures [in VBP] match up with what physicians are asked to do. Many people voiced the same comment in the listening session.”
Although there are just 17 candidate measures proposed for the first year of the VBP program, the expectation is to add a considerable number as the program continues. Many candidate measures are similar or identical to those in the PQRI, such as giving aspirin on arrival and giving aspirin, beta-blockers, and ACE inhibitors on discharge for patients with acute myocardial infarction.
Additionally, the proposed measures are identical to those in the current P4P program most hospitals already participate in, known as Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). The difference will be that instead of getting credit just for reporting the data as they do now, starting in 2009 hospitals must report publicly and perform at a certain level to get a payment update.
“Physicians, especially hospitalists, will need to watch this closely, as it is expected that the PQRI program, which is similar to RHQDAPU on the hospital level, will ultimately transition to a pay-for-performance program such as VBP,” says Dr. Seymann. “We can learn from the bumps in the road in the hospitals’ experience, and hopefully SHM can be active in ensuring that similar problems are anticipated prior to a physician-level pay-for-performance rollout. Furthermore, measures that will apply to hospitalists will likely mirror the hospital VBP measures.”