[vc_row][vc_column width=”1/1″][vc_heading title=”Value Based Purchasing” type=”h3″ style=”style1″ divider_width=”default” divider_color=”light” text_transform=”uppercase” color=”primary” align=”left” margin_bottom=”20″][/vc_column][/vc_row]
The Center for Medicare and Medicaid Services (CMS) pays hospitals for treating Medicare patients. As part of its payment program it has establish a program called Value Based Purchasing (VBP). In the program, CMS withholds from each hospital a percentage of its payment. The percentage varies per year. Each hospital has the ability to earn back less, all or more than what was withheld based on its success in treating it’s Medicare patients based on certain quality measures, such as Core Measures (defined below), patient satisfaction (based on the HCAHP scores), an efficiency measure (cost of the services provided) and outcome measures (mortality and infection measures). All of the money is earned back by the hospitals so if a hospital does really well it takes financial resources from one that does less well. CMS has the ability to change what it is measuring each year.
Hospitals voluntary report CMS identified patient treatment information/outcome information to CMS. This information is considered to the standard of practice (for example, an aspirin at the time of a suspected heart attack). Hospitals refer to these reported measures as “core measures”. The measures are publicly reported on one of CMS’s websites, www.medicare.gov/hospitalcompare. The public can compare up to three hospitals on many quality indicators, outcomes and patient satisfaction.
CMS and other insurers are looking at other patient treatment/outcome information as a means to determine quality. Readmission to the hospital is one of those indicators. Depending on the insurer they might look at a return to the hospital with in 7, 14 or 30 days. They might also be looking at returns to the emergency department in that same time frame. Another issue is any type of infection, whether it is medical or a surgical wound infection.
CMS, in particular, has tied these issues to reimbursement and has established penalties for hospitals if they have a high than expected (as defined by CMS) readmission for certain conditions or certain types of infections.
Hospitals are continually looking to improve all of the indicators mentioned above. Healthcare Council works with our members to provide education on best practices and provides networking opportunities for the membership to share their strategies to improve patient care and reduce readmissions.