Mandated by the Patient Protection and Affordable Care Act of 2010, the CMS' Hospital Value-based Purchasing Program is designed to provide incentive payments to hospitals that meet set performance standards for selected quality measures. The proposed rule, released Jan. 7, marks a significant departure from the current system, which rewards hospitals for reporting quality data through the Hospital Inpatient Quality Reporting Program.
The CMS is accepting comments on the proposed rule until March 8, and the agency said it expects to issue the final rule later this year.
“The Hospital Value-based Purchasing Program will reward hospitals for improving patients' experiences of care, while making care safer by reducing medical mistakes,” CMS Administrator Dr. Donald Berwick said in a news release. He called the proposal “a huge leap forward in improving the quality and safety of America's hospitals for both Medicare beneficiaries and all Americans.”
Under requirements in the health reform law, the CMS may use only measures for value-based purchasing that have appeared on Hospital Compare—the agency's quality data website for consumers—for at least one year. That means the 25 measures chosen for fiscal 2013, when the program is set to begin, are already familiar to providers.
“There are no real surprises,” said Stuart Guterman, vice president for payment and system reform at the New York-based Commonwealth Fund, and executive director of the organization's Commission on a High Performance Health System. “From what I have seen, it looks like the proposed rule is consistent with what CMS is required to do, and hospitals have been receiving incentives for reporting on these measures for some time now.”
According to the framework outlined in the proposed rule, hospitals would be eligible to receive incentive payments for discharges occurring on or after Oct. 1, 2012. For 2013, those payments would be based on a nine-month performance period beginning July 1, 2011, and ending March 31, 2012. Future versions of the program will likely use a full year of performance data, the CMS said.
As proposed, the program is also budget-neutral. In order to provide the cash for incentive payments, hospitals will lose a percentage of their base operating DRG payments—1% in fiscal 2013 and 2% beginning in fiscal 2017. But providers will have the opportunity to recoup those funds through their performance in the value-based purchasing program.
The proposed scoring system will recognize achievement and improvement. Providers will be scored from 0 to 10 for each measure, according to their baseline value and their score during the performance period.
For 2013, those proposed measures include 17 clinical quality measures in areas such as surgical-care improvement, and care of pneumonia and heart failure. In addition, the CMS proposed the use of eight measures from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which measures patients' satisfaction and experience of care. Those measures include communication with doctors and nurses, pain management and communication about medicines.
“The addition of information about patient experience is a critically important aspect of quality of care and it's a good way to assess how patients feel about the care that they receive,” Guterman said. “In many cases, it's probably as good a predictor of outcomes as many of the clinical quality measures.”