Hospital value based purchasing scores highly associated with prior year score and organizational characteristics

Abstract

Objective: Medicare’s Hospital Value Based Purchasing program (HVBP) rewards hospitals which achieve a higher than mean Total Performance Score (TPS). This article investigates the relationship between hospital characteristics and prior year Total Performance Score (TPS) on current year TPS under Medicare’s Hospital Value Based Purchasing (HVBP) program.Methods: Regression analyses are used to investigate the relationship between prior year TPS and organizational characteristics on current year TPS.Results: Regression analyses show that certain geographic locations, smaller bed size, and lower disproportionate share hospital percentage (DSHPCT) lead to a significantly higher TPS in both FY 2015 and FY 2016. Teaching status is associated with higher scores in FY 2015 and lower scores in FY 2016. Furthermore, prior year TPS is a significant predictor of current year TPS.Conclusions: Results suggest HVBP performance is dependent upon organizational characteristics which may have little to do with quality or cost of care. Furthermore, the findings demonstrate that prior year HVBP performance is the strongest predictor of future performance which may impede low performing hospitals from achieving success in future years, despite significant gains in improving cost and quality.

Evaluating the robustness of the CMS Hospital Value‐Based Purchasing measurement system

“…This suggests the highest performing hospitals, with presumed excellence in processes and outcomes, can maintain their status year after year and prevent others from increasing in rank. This is supported by recent research which found prior‐year TPS is the most significant predictor of current year TPS 10 . And may suggest lower performers cannot increase their rank easily, despite earning points for improvement over self.…”

“…It is also possible that the expense associated with improving TPS is greater than the lost revenue for some hospitals, particularly as certain hospital characteristics are associated with TPS. 8,9,10,16 A qualitative study would be needed to explore this assertion. Last, the transitory probability analyses only included the Top and Bottom 5% of hospitals, while this limits generalizability, it did demonstrate that the extremes in scores were not static.…”

“…They found higher TPS scores in both years for hospitals in specific geographic locations, smaller bed size, and lower disproportionate share. 10 Thus, there is an apparent association between performance outcomes and a few hospital characteristics, such as DSHI, for-profit ownership, hospital bed size, and geographic region, which can advantage or disadvantage hospitals as they seek to maximize their TPS.…”

“…This is supported by recent research which found prior-year TPS is the most significant predictor of current year TPS. 10 And may suggest lower performers cannot increase their rank easily, despite earning points for improvement over self.…”

“…It also found for‐profit status had a positive association with the TPS, as well as certain regions of the country 8,9 . A subsequent study concluded hospitals with higher DSHI values received significantly lower Medicare payment adjustments 10 . Chen et al (2019) used regression analyses to evaluate TPS between FY 2015 and 2016.…”