Four years into Medicare's value-based purchasing program, more hospitals than ever are earning bonuses, and the top-performing ones are getting bigger rewards.
But policy experts and hospitals themselves remain dubious that the program has much influence over healthcare quality.
Last week, the CMS published the 2016 bonuses and penalties for the more than 3,000 hospitals that are subject to value-based purchasing, which adjusts the amount hospitals receive from Medicare based on how they perform on 25 measures of quality, patient experience and spending.
The good news is that the number of hospitals seeing a positive adjustment in 2016 for their performance increased by about 160 hospitals to more than 1,800. And the bonuses topped out a full percentage point higher than last year's.
Value-based purchasing is one of several Affordable Care Act initiatives that incrementally change how Medicare pays hospitals and doctors. Under these efforts, a growing percentage of what providers earn from Medicare depends on their performance on measures of quality, safety and the cost of patient care.
The money at stake in each individual program is modest—1% to 3%. But performance across all programs, combined with incentives to adopt electronic health records, will account for 7% of Medicare reimbursement this year, and will increase to 8% in 2016.
Few hospitals are coming out ahead. An Advisory Board Co. analysis found that 85% of hospitals took a cut from Medicare after calculating the combined effects of value-based purchasing and the reform law's initiatives targeting readmissions and hospital-acquired conditions.
Still, the incentive to change depends on how much the penalties cost individual hospitals, said Eric Fontana, a practice manager for the Advisory Board. And the amount value-based purchasing contributes to that sum isn't much for most of them. The average bonus in 2016 was 0.59%, compared to an average penalty of 0.33%, an analysis by Avalere Health found.
The newest round of results follows a Government Accountability Office report in early October that found “no apparent shift in existing trends” in quality during the value-based purchasing program's first three years.
Even some of the top-performing hospitals say value-based purchasing isn't much of a factor in their quality improvement efforts.