Hospital value‐based purchasing

Abstract

Hospital Value Based Purchasing (VBP) aims to incentivize inpatient providers to delivery high value, as opposed to high volume, health care. The formal mandate of hospitals to provide high value health care through financial incentives marks an important change in Medicare and Medicaid policy. In this opportune review of VBP, we discuss the relevant historical changes in the reimbursement environment of U.S. hospitals that have set the stage for VBP. We describe the structure of the Centers for Medicare and Medicaid Services' VBP program, with a focus on which hospitals are eligible to participate in the program, the specific outcomes measured and incentivized, how rewards and penalties are allocated, and how the program will be funded. In an effort to anticipate some of the issues that lie ahead, we then highlight a number of potential challenges to the success of VBP, and discuss how VBP will impact the delivery and reimbursement of inpatient care services. We conclude by examining how the VBP program is likely to evolve over time. The Centers for Medicaid and Medicare Services' (CMS) Hospital Inpatient Value-Based Purchasing (VBP) Program, which was signed into law as part of the Patient Protection and Affordable Care Act of 2010, aims to incentivize inpatient providers to deliver high-value, as opposed to high-volume, healthcare.1 Beginning on October 1, 2012, the start of the 2013 fiscal year (FY), hospitals participating in the VBP program became eligible for a variety of performance-based incentive payments from CMS. These payments are based on an acute care hospital's ability to meet performance measurements in 6 care domains: (1) patient safety, (2) care coordination, (3) clinical processes and outcomes, (4) population or community health, (5) efficiency and cost reduction, and (6) patient-and caregiver-centered experience.2 The VBP program's ultimate purpose is to enable CMS to improve the health of Medicare beneficiaries by purchasing better care for them at a lower cost. These 3 characteristics of care-improved health, improved care, and lower costs-are the foundation of CMS' conception of value.1,2 They are closely related to an economic conception of value, which is the difference between an intervention's benefit and its cost.Although in principle not a new idea, the formal mandate of hospitals to provide high-value healthcare through financial incentives marks an important change in Medicare and Medicaid policy. In this opportune review of VBP, we first discuss the relevant historical changes in the reimbursement environment of US hospitals that have set the stage for VBP. We then describe the structure of CMS' VBP program, with a focus on which facilities are eligible to participate in the program, the specific outcomes measured and incentivized, how rewards and penalties are allocated, and how the program will be funded. In an effort to anticipate some of the issues that lie ahead, we then highlight a number of potential challenges to the success of VBP, and discuss how VBP will impact the del...

Development and validation of the tool to assess inpatient satisfaction with care from hospitalists

“…Reliability of TAISCH was good (Cronbach's a 5 .88). The hospitalists' average TAISCH score ranged from 3.25 to 4.28 (mean [standard deviation] 5 3.82 [0.24]; possible score range: [1][2][3][4][5]. The relationship between TAISCH with a validated empathy scale and a global provider satisfaction question revealed significant positive associations (b 5 .14, and b 5 .54 respectively, both P < 0.001).…”

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

“…VBP is a payment system that holds providers accountable for both the quality and cost of healthcare that they supply; therefore, it links payments with improved performance by healthcare services providers (6)(7)(8). HVBP is a type of VBP in inpatient hospital settings, used as a tool for improving the quality of care and a reasonable cost reduction, and it is considered a type of P4P (6,9). Health insurance systems, such as Medicare, have developed plans and models for purchasing the required inpatient care and healthcare services with the desired quality and the lowest cost (6,10).…”

“…Health insurance systems, such as Medicare, have developed plans and models for purchasing the required inpatient care and healthcare services with the desired quality and the lowest cost (6,10). HVBP has been used for the first time by the CMS in the United States (9,10).…”

“…The HVBP in services and inpatient care has undergone continuous changes over recent years, as the latest editions in 2015 (10) comprised a review of four essential dimensions of hospital services, which included: quality of clinical care, patient experience, outcome, and efficiency (18). Each of these four dimensions has criteria and sub-criteria for measurement, and combination adjust marker is used to measure some of them (9,10,18,19).…”

“…In contrast, HVBP model has increased the quality of care and reduced costs by linking payments to acceptable performance (6,9,10,19). Studies conducted in the US health system have indicated a very high effect of the inpatient care purchasing strategy type on the quality of care (6,10,27,28).…”