Blanchard Valley Health System's Value-Based Purchasing Interactive Performance Modeler (VBPIPM) converts retrospective Centers for Medicare and Medicaid Services Value-Based Purchasing data into actionable information that hospitals can use for targeted quality improvement interventions and related physician and staff education. The Solution calculates and stratifies the dollars lost or gained by the hospital for each of the 20 measures.

The Value-Based Purchasing Interactive Performance Modeler contains the following components:
- Detailed Performance Modeler Implementation and Training Guide
- Interactive Excel Spreadsheet Quantifying Financial Impact of Quality Improvement Efforts under CMS's Value-Based Purchasing Program
- One Hour Phone/Webinar Consultation with Solution Champion
- Quarterly Data Analysis Based on Hospital's Internal Data Available


Below you will find a series of questions and answers that will guide you through the objectives, implementation, and outcomes of Blanchard Valley Health System's Value-Based Purchasing Interactive Performance Modeler (VBPIPM).

The CMS Value-Based Purchasing (CMS VBP) program will withhold a percentage of Medicare revenue for the majority of U.S. hospitals starting in January 2013, based on the hospital's performance on 12 clinical and 8 experience of care measures. The CMS VBP program provides an opportunity for a hospital to regain a portion or a multiple of the hospital's withhold percentage based on the hospital's performance on these 20 measures.

The Value-Based Purchasing Interactive Performance Modeler (VBPIPM) converts retrospective CMS VBP data into actionable information that the hospital can use for targeted quality improvement interventions and related physician and staff education. The tool calculates and stratifies the dollars lost or gained by the hospital for each measure. More importantly, for each measure it quantifies the financial impact of each instance of the measure not being met. With this tool, a hospital can monitor performance and proactively target efforts to improve the percentage of withhold returned based on results for each or any of the 20 measures for 2012.

The ability to place a dollar value on each instance of failure to meet a measure and to perform “what if” analyses brings the CMS VBP results to life for clinical staff, motivating improvement. Used in combination with hospital's own data set, this tool allows the hospital to identify the physician, care giver or nursing floor for each instance of a measure not being met, in order to focus on interventions and education.

What problem does this Solution address?

The existing reporting of results to each hospital from CMS will identify the 20 measures and an overall dollar amount returned based on performance on the measures during the time period. The report is in aggregate and is retrospective, and does not allow the hospital to directly quantify the impact of improvement efforts on any individual measure, because the CMS VBP methodology is not focused on individual measure dollar impacts.

The tool will calculate the financial impact of performance on the CMS VBP overall and for each measure individually, as well as tying a specific dollar amount to each instance of a measure not being met. The tool will stratify the relative financial loss or gain from improved performance on the measures. The tool has the ability to perform “what if” analysis based on improvement of any single measure, or to incorporate a change in the number of patients (fall outs) on a measure. The “what if” analyses generate new aggregate results as well as results by each measure, including dollar loss or gain by measure and total dollars returned.

The tool allows the hospital to identify the dollar impact for loss or gain for any measure. This allows the hospital to focus on areas that will have the largest financial results to the hospital as well those with significant clinical and experience of care improvement for their patients.

How was the Solution developed?

The final rule by CMS for (VBP) Value-Based Purchasing was reviewed to determine the elements, methodologies, benchmark and performance periods and overall timing of Value-Based Purchasing. The Blanchard Valley Health System developed the Performance Modeler using Excel so that the tool incorporates the calculation methodology of CMS and utilizes a hospital's individual results from CMS to generate dollars returned, points by measure and dollars withheld based on the hospital's Medicare revenue.

The tool incorporates the ability to change key “what if” conditions including changed patient numbers (fall outs) for a measure or the number of “failure” instances on a specific measure. The model generates results for aggregate dollars returned. The tool also has the ability to input data more frequently based on the hospital's access to timely clinical and experience results from their internal or external vendors. This tool is flexible and capable of modeling changes in performance over time, using the required data from CMS or similar more recent data from an internal system, allowing the hospital to determine a very close approximation of performance and the dollar impact of that performance under the CMS VBP methodology.

This tool was developed to allow a better understanding of opportunities for potential improvement and areas where a small change can make a large financial impact, and it accomplished those tasks completely.

Were there any organizational considerations?

Communication to stakeholders was done through a series of meetings with management and physicians with emphasis on the impact associated with respective (fall out) patients, point performance and dollars associated with each measure.

What are the resources, staffing and skills needed to successfully implement this Solution?

This Modeler itself is very easy to use with all data input cells identified and unlocked. The cost of operation of the tool itself would be minimal and would be based on the recurring frequency of data analysis. The data can be entered into the required cells for any hospital in less than 10 minutes once the data is available from CMS. If a hospital has the ability to collect their own data from an internal or external vendor then the data entry for that activity once obtained and validated can typically be entered into the tool within 15 minutes. The value of the tool is realized when it is used by the quality and performance improvement infrastructure of the hospital to guide improvement efforts and to educate physicians and staff (“the roll-out”). The resources required for the “roll-out” are likely to exist within a hospital. The (VBPIPM) will help focus and drive those improvement efforts.

What does the Program include? What does the optional Quarterly Analysis entail?

The Program includes an in-depth training manual, the interactive Excel spreadsheet that quantifies the financial impact of a hospital's quality improvement efforts under CMS's Value-Based Purchasing Program and a one (1) hour Phone or Webinar consultation with the Solution Champion to explain and help implement the program. The Quarterly Analysis option takes the program one step further. Once the Licensee inputs the data into the interactive spreadsheet, they will then send the file to Blanchard Valley Health System for analysis. The Quarterly Analysis option includes seven (7) additional hours of analysis and reporting via phone and/or webinar by the Solution Champion on a quarterly basis.

Any advice to other hospitals and health systems in preparation to launching this Solution?

The only prerequisite for this tool is having basic understanding of Microsoft Excel. The output results of this tool when shared with administration, physicians and nursing staff should provide the catalyst for ongoing discussion and improvement.

How has this Solution performed?

Based on Blanchard Valley Health System results for Calendar Year (CY) 2010 compared to CY 2011- which identifies the pre VBP and post VBP activity - our performance point scores, dollars back and patient (fall outs) loss reduction were all improved. An estimated $20M annual Medicare revenue was used for each analysis period and a moderate return slope of 2.0 (this is a budget neutral project as indicated by CMS so all dollars withheld will be redistributed), we were able to improve our dollars back for CY 2010 from a loss of ($38,000) to a positive $30,000 in 2011. The actual slope (Hospital Compare best to worst hospitals) for 2011 is expected to be greater than 2.5 which would dramatically increase the dollars back.

What are the key elements needed to SUSTAIN this Solution?

This program requires communication back to all the stakeholders, including administration, nursing and physicians as frequently as possible so that corrections can be made in both the process of care and the experience of care for patients. At a minimum reporting of results on an annual basis (or quarterly if data is available from internal and external systems) is recommended.