Patient experience, based on results from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, remained unchanged at 30%, although hospital officials balked at its inclusion, arguing sicker patients are more apt to criticize hospitals, thus bringing scores down.
As a concession, the CMS moved to avoid penalizing hospitals hurt from skewed survey data and will exclude answers from hospitals with fewer than 100 respondents during the performance period.
The process remains in its infancy, said Stuart Guterman, executive director of the Commonwealth Fund's Commission on a High Performance Health System. There's going to be some trial and error, he said.
“I think there are always problems when you're trying to design value,” Guterman said. “But I think the general focus on paying for value rather than paying for volume is a good one.”
Establishing consistency remains the most pressing concern,and providers need a clearer picture of their targeted goals, Guterman said. Though he agreed that the CMS is moving in the right direction, he worried about the notion of incentives.
“Frequently, the word ‘incentive' is seen as taking a bribe for behaving in a certain way,” he said. “Any movement away from that principle is an important one and we'll find our way along the path in the first few steps in a movement toward improvement of the healthcare system.”
AHA officials also lauded the CMS.
“America's hospitals firmly support the VBP program, which is designed to help hospitals improve patient care,” AHA Executive Vice President Richard Pollack said in a prepared statement. “That is why the AHA earlier this year voiced strong concerns about the way CMS was establishing quality and efficiency measures under the program.”
Eventually, the proper metrics will be developed, Kahn said, and any of the measurements that disappeared will return in subsequent iterations of value-based purchasing. “More time is really being allowed for bringing the metrics online.”