Association between value-based purchasing score and hospital characteristics

Abstract

BackgroundMedicare hospital Value-based purchasing (VBP) program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments.The objective of the study was to assess the association of hospital characteristics with (i) the mean VBP score, and (ii) specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC) score and patient satisfaction score.MethodsObservational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS) regression and quantile regression (QR), respectively.ResultsVBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit), smaller bed size (vs. 100–199 beds), East South Central region (vs. New England region) and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients) were positively associated with mean VBP scores (p<0.01 in all). Total number of CPC measures reported, bed size of 400–499 (vs. 100–199 beds), a few geographic regions (Mid-Atlantic, West North Central, Mountain and Pacific) compared to the New England region were negatively associated with mean VBP score (p<0.01 in all). Disproportionate share index, proportion of Medicare and Medicaid days to total inpatient days had significant (p<0.01) but small effects. QR results indicate evidence of differential effects of some of the hospital characteristics across low-, medium- and high-quality providers.ConclusionsAlthough hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.

Who presents satisfied? Non-modifiable factors associated with patient satisfaction among gynecologic oncology clinic patients

“…This study agrees with previous work in other disciplines that patient satisfaction scores are affected by non-modifiable patient and system factors, such as the age of the patient or the size of the hospital (8, 9). In a cohort of gynecologic oncology patients in an outpatient setting, we found that patient satisfaction scores are associated with non-modifiable demographic, financial and geographic factors.…”

“…Other studies have found lower satisfaction scores for patients who are non-English speakers (8). At the systems level, lower patient satisfaction scores have been observed for densely populated urban areas, hospitals with more beds and those that are non-profit or academic (8, 9). The consistent variation of patient satisfaction by non-modifiable factors suggests that patient satisfaction may be measuring factors beyond just the quality of healthcare delivered.…”

Demographic factors and hospital size predict patient satisfaction variance—implications for hospital value‐based purchasing

“…Prior studies have suggested that large, urban, teaching, and not-for-profit hospitals were disadvantaged based on their hospital characteristics and patient features 10–12 . Under the current CMS reimbursement methodologies, these institutions are more likely to receive financial penalties 8 .…”

“…HVBP portends significant economic consequences for the majority of hospitals that rely heavily on Medicare and Medicaid reimbursement as most hospitals have large revenues but low profit margins 11 . Higher HVBP scores are associated with for profit status, smaller size, and location in certain areas of the U.S. 12 . Jha et al 6 described HCAHPS scores regional geographic variability but concluded that poor satisfaction was due to poor quality.…”

Proposing a Model of “Hospital Value-Based Purchasing” in Selected Teaching Hospitals in Isfahan, Iran: 2015 - 2016

“…The HVBP is computed using the following four dimensions (9,18,34,37,47,48): -Efficiency (E) In the US model of HVBP, the weights of the HVBP dimensions are expressed in terms of TPS (4,18,37,48). TPS in VBP is calculated based on four dimensions including quality of clinical care 20%, patient experience 30%, outcome 30%, and efficiency 20% of TPS in 2016 -2017 (18,37,(48)(49)(50):…”