Healthcare Business News

CMS shows first winners, losers in value-based purchasing

By Modern Healthcare
Posted: December 20, 2012 - 10:00 pm ET

Medicare will reward 1,557 hospitals with more money and reduce payments to 1,427 others starting Jan. 1 under its value-based purchasing program, according to a Kaiser Health News analysis of CMS records.

The CMS released a spreadsheet of the revised payments on its website Dec. 20.

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“We've known for a long time that when Medicare paid providers based on how much work they did and not on how well they did for patients, too often patients got services and tests that didn't improve their health,” CMS Chief Medical Officer Dr. Patrick Conway wrote in a blog post about the data.

Under a provision of the Patient Protection and Affordable Care Act, Medicare has tied 1% of hospitals' payment to performance on a set of clinical process-of-care measures and patient experience metrics. Funds for the program, estimated at $850 million for 2013, come from an across-the-board 1% cut in base operating DRG payments.

The Kaiser analysis found that nearly two-thirds of the hospitals will have payment changes of less than a quarter of a percent.

A separate analysis by the Harvard School of Public Health and cited by Kaiser found that bigger hospitals, teaching hospitals and hospitals with the most poor patients tended to do worse under the program. The Harvard analysis found that 57% of for-profit hospitals will receive bonuses, compared with 21% of public hospitals.

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