I'm sure that many of you are just like me: I have many meetings each week looking at the overall operations of our organization. It may just be me, but there seems to be a growing number of items that, if not watched very carefully, could potentially have a negative impact on our ability to get reimbursed for the care we provide.
One item that we have been reviewing on a more regular basis is the scorecards related to the value-based purchasing program, which will soon be in full swing. As our senior leadership team studies all of the variables that go into value-based purchasing, we find that the program has made us more focused on many of the specific and related clinical processes. It also has caused us to be more sensitive to the data-collection and reporting process.
The value-based purchasing program is designed to be an initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to people covered by Medicare. Value-based purchasing changes the way the CMS pays hospitals, rewarding hospitals for higher quality of care, not just for doing more procedures.
The proposed program, mandated by the Patient Protection and Affordable Care Act, will provide incentive payments and penalties based on performance or improvement on a set of clinical and patient experience-of-care quality measures for discharges occurring on or after Oct. 1, 2012. The financial incentives will be funded by a reduction in the base operating DRG payments for each discharge, which will be 1% in fiscal 2013, rising to 2% by fiscal 2017. As hospitals pay into this pool through the reduction in reimbursement, hospitals that score well (that is, demonstrate improvement) in relation to all other hospitals will be paid out of that pool.
Simply stated, there will be winners and there will be losers. Which group your facility is in will depend on how well it can perform on the required quality performance measures.