Of the hospitals included in the program for 2014, 1,231 will see their payments increase, while 1,451 will be paid less.
Some experts argue the program's selection of winners and losers each year could discourage some hospitals that are working hard to improve quality but still ending up in the penalty range. “It's a moving target,” said Harold Miller, president and CEO of the Pittsburgh-based Center for Healthcare Quality and Payment Reform.
Also, Miller said, the program still relies too heavily on process-of-care measures rather than measures of actual patient outcomes.
Gallup (N.M.) Indian Medical Center, a 71-bed U.S. Indian Health Service hospital, will receive the largest penalty in the upcoming year, a reduction of 1.14%. The hospital was on the penalty side in 2013 as well, losing 0.4% of its Medicare payments. Arkansas Heart Hospital, a 112-bed specialty hospital in Little Rock, will see its payments jump by 0.88%, the largest payment increase of any participating hospital for 2014.
The program is budget-neutral and is funded through an across-the-board 1.25% cut in hospital's base-operating DRG payments—up from 1% in 2013. That cut is expected to generate more than $900 million, according to federal estimates. The percentage withheld from hospital payments increases incrementally in quarter percentage points over the next two years before topping out at 2% in 2017.