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Value-based purchasing program could sock safety net facilities: study


By Maureen McKinney
Posted: July 16, 2012 - 2:15 pm ET
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The CMS' fast-approaching value-based purchasing program could spell trouble for financially strapped safety net hospitals, whose patient-experience scores tend to lag behind those of other hospitals, according to a study published online in the Archives of Internal Medicine.

The program, set to begin Oct. 1, will link a portion of hospitals' payment update to performance on a set of 12 clinical quality measures and a composite measure of patient experience. But according to researchers from the Harvard School of Public Health, Boston, hospitals that care for large percentages of poor patients typically score worse than other hospitals on patient-reported metrics of experience, such as communication with physicians and discharge instructions.

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Using two years of data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey—2007 and 2010—the study's authors evaluated patient experience scores at nearly 3,100 hospitals, including 769 safety net hospitals.

Safety net hospitals scored lowest on every patient experience measure except quietness of hospital environment, the authors found. Based on 2010 data, safety net hospitals had 60% lower odds of meeting the value-based purchasing program's achievement benchmark, they said.

The study is just the latest of several that have questioned whether using HCAHPS data in value-based purchasing will have an uneven impact on hospitals that serve large numbers of poor patients.

The CMS has defended its program in the past, arguing that it built in safeguards by rewarding not only achievement but also improvement from hospitals' baseline levels of performance.

Safety net hospitals' patient experience ratings did improve from 2007 to 2010, the authors found, but the rate of improvement was slower than that of other hospitals.

“Although the new VBP rules pay for improvements as well as achievement, our findings suggest that (safety net hospitals) face challenges on both fronts,” they wrote in the study. “If SNHs are unable to substantially improve patients' experience over the next several years, hospital-based incentive programs are likely to disproportionately penalize these institutions.”


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