Transcript Open Door Forum: Hospital Value

Hospital Value-Based Purchasing Update
Jim Poyer
Director, 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)
2
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
3
Hospital Value-Based Purchasing (VBP)
Proposed Measure Topics
FY 2013:

Process of Care Measures
–
–
–
–
FY 2014:

Process of Care Measures: Use all
2013 Measures, plus add 1 SCIP
Clinical Process Measure

Patient Experience of Care:
Acute Myocardial Infarction (AMI)
Heart Failure (HF)
Pneumonia (PN)
– Hospital Consumer Assessment of
Surgical Care Improvement Project
(SCIP)
Healthcare Providers and Systems
(HCAHPS) Survey
– Healthcare Associated Infections
(HAIs), as defined by the Secretary’s
HAI Action Plan

Patient Experience of Care:
NEW TOPICS

Outcome Measures:
– 30-day mortality measures: AMI, HF,
– Hospital Consumer Assessment of
and PN
Healthcare Providers and Systems
(HCAHPS) Survey
– AHRQ Patient Safety Indicators and
Inpatient Quality Indicators
– Hospital Acquired Conditions

Efficiency Measure:
– Medicare Spending per Beneficiary
4
How Will Hospitals Be Evaluated under
the 2013 Hospital VBP Program?

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
5