ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM:
|
|
- Vincent Willis
- 7 years ago
- Views:
Transcription
1 ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT November 2015 David Muhlestein, PhD, JD
2 INTRODUCTION The Hospital Value-Based Purchasing (HVBP) program 1, originally implemented by the Centers for Medicare and Medicaid Services (CMS) in 2013, is designed to financially incent hospitals to provide better services to Medicare beneficiaries. The HVBP is one of three CMS valuebased programs for hospitals along with the Hospital Readmission Reduction Program (HRRP) 2 and the Hospital Acquired Conditions Reduction Program (HAC). 3 However, the HVBP is unique in two ways. First, it is structured 4 to be revenue neutral so that some hospitals will receive bonus payments while others will receive penalties for inpatient payments. Second, it evaluates performance across four diverse weighted domains including clinical process of care (weighted at 10%), patient experience of care (25%), clinical outcomes (40%), and efficiency (25%). Recently, final hospital payment adjustments for fiscal year 2016 were released which offer an opportunity to evaluate how hospitals are performing and provide some assessment of the broader program. RESULTS The HVBP is designed to financially incent hospitals to provide better services to Medicare beneficiaries Hospital Differences. For fiscal year 2016, which began October 1, 3,041 hospitals received payment adjustments based on performance in Penalties for 2016 will be limited to a maximum of 1.75% of Medicare payments and bonuses will be limited to a maximum of approximately 3%. Table 1 contains some general characteristics of the hospitals broken down by whether they received a bonus or a penalty. Hospital data was acquired from Medicare Cost Reports and a commercial database of hospitals. Hospitals that received a bonus tended to be smaller, saw fewer Medicaid patients, were more likely to be located in rural areas, less likely to be an academic medical center, and less likely to be part of a network. Table 1: Characteristics of Hospitals for Value-Based Purchasing 2016 Characteristic Number of Hospitals Average Bed Size Average Number of Discharges Average Net Operating Margin* Percent of Hospital Days Paid by Medicaid Percent of Hospitals that are For Profit Percent of Hospitals in Rural Location Percent of Hospitals that are Academic Medical Centers Percent of Hospitals Part of a Network Received Bonus 1, , % 10.8% 24.1% 10.9% 6.9% 74.0% Received Penalty 1, , % 12.6% 26.6% 4.0% 17.9% 82.1% P-Value for Difference *Excludes outliers Regional Differences. Hospital performance on the HVBP also varied across the country. We estimated average state scores by averaging hospital performance in each state, weighting by hospital size. Figure 1 shows a map of the better and worse performing regions of the country with average state HVBP scores. The scores represent the average Medicare bonus or penalty as a percent of Medicare revenue. The highest performing states tended to be in the Upper Midwest and Pacific Northwest while the worst-performing states were scattered throughout the country. FIGURE 1: Average Hospital Value-Based Purchasing Adjustment for Medicare by State Source: Leavitt Partners Research % Change in Payments 0.21 to to to to to to to No Data ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT 1
3 Value-based payment bonuses and penalties are intended to be revenue neutral across the country, but will significantly affect individual hospitals. We estimated the dollar effect by multiplying the percent bonus or penalty by the hospital s net inpatient revenue and the percent of hospital discharges that were paid for by Medicare. At the extremes, individual hospitals are expected to lose as much as $8 million or gain over $6 million. Impact on Total Financial Performance. For the hospitals subject to the HVBP modifier, an average of 35.4% of discharges are paid for by Medicare and 46.1% of revenue is from inpatient care. Since the modifier only affects Medicare inpatient care, on average the modifier will only affect approximately one-sixth of their revenue. For 2016 we estimate that the net effect on a hospital s income will be affected by the HVBP modifier from a maximum of a 0.35% decrease in total revenue to a maximum increase of 0.8% in total revenue with a median effect of a 0.02% bonus payment. Only 4.9% of hospitals, though, are expected to see a penalty or bonus payment that exceeds 0.25% of their net revenue, and of those hospitals, only 8.3% will be penalized. Figure 2 contains a histogram of the estimated effect of the HVBP modifier on total patient revenue. Number of Hospitals FIGURE 2: Histogram of Value-Based Modifier s Estimated Effect on Total Patient Revenue Estimated % Effect on Total Patient Revenue Performance over Time. Payment modifiers for the HVBP program are calculated annually giving hospitals an opportunity to improve their performance. Table 2 contains a count of the number of hospitals that received penalties or bonuses in 2015 and Approximately 45% of hospitals received a bonus in both 2015 and 2016 while another 30% were penalized in both years. Approximately 25% of hospitals made a change between the two categories, either moving from bonus to penalty (11%) or penalty to bonus (14%). Table 2: Hospital Performance in Value-Based Purchasing Program between 2015 and 2016 Penalty in 2016 Bonus in 2016 Penalty in 2015 Bonus in Changes were also substantial for hospitals with their various levels of performance. We classified hospitals into quintiles based on their 2015 and 2016 HVBP modifiers and calculated the amount of movement between categories. 308 hospitals were in the lowest quintile for both years and 370 were in the highest quintile for both years. However, there is a surprising amount of movement between the quintiles. 1,193 hospitals (40%) moved up or down one quintile, 398 (13%) moved two quintiles, 119 (4%) moved three quintiles, and 22 (1%) moved four quintiles, meaning they either went from the highest quintile in 2015 to the lowest in 2016 (six hospitals) or went from the lowest in 2015 to the highest in 2016 (16 hospitals) ,331 In past years the HVBP program made significant changes to the scoring methodology, such as newly adding the efficiency metric for 2015, but only very modest scoring changes were made between 2015 and Since the observed differences cannot be attributed exclusively to changes in methodology, this means that hospitals have significantly improved or 1 The weighting for clinical processes of care decreased from 20% in 2015 to 10% in 2016 while the weighting for clinical outcomes increased from 30% to 40%. ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT 2
4 worsened their performance over the course of just one year. Table 3 contains a breakdown of hospital performance by quintile in 2015 and Value-Based Purchasing Quintile 2015 Table 3: Hospital Value-Based Purchasing Performance by Quintile for 2015 and 2016 Lowest Highest Value-Based Purchasing Quintile 2016 Lowest Highest Comparison to Other Programs. In addition to the HVBP Program, CMS has also initiated the Hospital Readmission Reduction Program (HRRP) and the Hospital-Acquired Condition (HAC) Reduction Program. While all three programs are intended to improve hospital performance, they focus on different areas HRRP data was released earlier this year while 2016 HAC data has not yet been released. High performance on one program is only mildly associated with high performance on another. HVBP scores are modestly correlated with HAC scores (corr=0.24) and much less correlated with HRRP scores (corr=0.06). Only 28 hospitals scored in the highest quintile for all three measures. POLICY IMPLICATIONS AND RECOMMENDATIONS FOR VALUE-BASED PURCHASING Value-Based Purchasing s Ability to Change Behavior. The stated goal of the HVBP program is to improve patient outcomes, safety, and patients care experience. An important question, though, is whether the program will provide enough of an incentive to hospitals to make changes to improve their delivery. The theory is that the threat of a penalty or possibility of a bonus will incent hospitals to improve their performance across the four measured domains. Improvement in any one of the domains will require significant investments of time, and potentially money, for hospitals. In many cases, the return on that investment is unknown. In total the HVBP includes 24 different measures 6 which means improvement on a single measure is unlikely to lead to a substantive change in the overall score, and simultaneously addressing many measures may prove to be overly difficult. As seen in Figure 2, the high majority of hospitals are either penalized or receive bonuses for a small percentage of their total revenue. With relatively small bonuses or penalties and a high investment in implementing changes required for an unknown potential return, the financial incentives may not be sufficient to justify significant changes for many hospitals. One approach to directly incent action is to move toward measures that have clear pathways for improvement. For example, there is no clearly defined route to improve physician-patient communication scores, making the decision to invest in improvements difficult for management. But, there is a much clearer approach to improve how many patients are provided appropriate discharge information measures with clearer pathways to improvement could be weighted higher than those with a more nebulous pathway forward. Important additional work needs to be done to assess whether hospitals that have higher penalties improved more than those that had smaller penalties or bonuses. Hospitals that are subject to higher penalties have a larger financial incentive to decide that they need to make significant changes to reduce those penalties than those that have marginal penalties or bonuses. Whether this plays out in practice still needs to be studied empirically; it needs to be clearly established whether the HVBP has sufficient power to influence broad changes. If providers with larger penalties do indeed tend to improve more, the program could modify its ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT 3
5 distribution of payments so that more hospitals have larger penalties or bonuses and fewer have modest changes. Some sample distributions for bonuses and penalties are in Figure 3. We reiterate, though, that meaningful additional analysis is needed in this area. -2.0% -2.0% -2.0% FIGURE 3: Current and Alternative Distributions of Value-Based Purchasing Bonuses and Penalties -1.6% -1.6% -1.6% -1.2% -0.8% -0.4% -0.0% 0.4% 0.8% 1.2% Approximate Current Distribution -1.2% -0.8% -0.4% -0.0% 0.4% 0.8% 1.2% Alternative Bimodal Distribution -1.2% -0.8% -0.4% -0.0% 0.4% 0.8% 1.2% Alternative Uniform Distribution 1.6% 1.6% 1.6% 2.0% 2.0% 2.0% Meaningful Differences in Performance Translate to Meaningful Differences in Payment. One of the major aims of the HVBP program is to be revenue neutral where bonus payments are offset by penalties and a certain percentage of hospital payments are withheld to be reapportioned. From a federal financing perspective this is desirable as the program can provide financial incentives to hospitals to improve while not increasing the cost of the Medicare program. The disadvantage of this approach is that it does not establish clear benchmarks that hospitals can try to achieve as their performance is annually compared to all other hospitals with a mandate to select high- and low-performing hospitals; there may reach a point where the practical difference between hospitals is not meaningful. For example, the patient experience of care domain includes a number of subdomains 7 such as the percentage of patients who reported that their doctors always communicated well. For 2015 (the most recently available data), the percent of patients at a hospital that said that their doctor always communicated well ranged from 70% to 96%, but the difference between the 50 th percentile and the 25 th percentile is only three percentage points (81 compared to 78). Given the sample sizes of respondents from some of the hospitals, this difference will often not be statistically significant but the absolute difference will lead to meaningful differences in performance scores for the HVBP program. The ultimate result may be that hospitals bonus payments or penalties are meaningfully affected by non-meaningful differences in performance that are attributable to chance. Patient experience is an important goal of CMS and so the need to measure and incent this must be weighed against the methodological limitations. To address this concern, CMS could limit the measures used in the HVBP program to those where there is a meaningful distribution of performance and within each category limit the number of potential scores to those that are substantially different. This may require moving from continuous scales to more categorical scales with clear cutoffs where meaningful differences exist between groups. It needs to be noted that these methodological concerns are not new and much has been done to improve CMS s measurements over the years, but more work is still needed. ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT 4
6 Volatility. The objective of the HVBP is for hospitals to improve their performance by making important changes in how they deliver care. High levels of volatility hospitals showing high increases or decreases in performance year over year may indicate that the program is not adequately measuring true underlying quality. For example, one hospital was in the lowest quintile in 2013, the highest quintile in 2014, back to the lowest quintile in 2015 and is now in the middle quintile in hospitals have seen at least a two quintile decline and two quintile improvement between different years. Such movement suggests that the program measures may be susceptible to random variation as opposed to a hospital actually alternating between worsening and improving every year. While some larger hospitals had high levels of volatility, the most volatile hospitals tended to be smaller facilities (116 beds compared to 206 beds; p). Smaller facilities have smaller patient populations with fewer cases being used to estimate population-level outcomes, leading to potential volatility with year over year estimates. A hospital, for example, that annually treats only a few dozen heart failure patients is much more likely to see yearly performance scores that vary much more than a hospital that treats many times that number simply due to clinical variation. A uniform program that is applicable to all hospitals is a laudable goal, but this may underestimate the substantive differences between organizations. High volatility, in particular, indicates a need to revisit whether there are sufficient cases to generate accurate measurements of performance. The efficiency domain, for example, only requires 25 cases 5 which will likely lead to significant variation year over year in measured performance, even if actual performance is relatively constant. Reduction in volatility due to random changes over time can be limited with a higher threshold of minimum cases which would lead to smaller hospitals being excluded from the HVBP program. CMS could recognize this and devise an alternative, low-case volume HVBP program which crafts measures that would be more appropriate for those facilities. This would allow CMS greater flexibility to customize measures that will influence different types of hospitals to improve in ways that are appropriate for the facility. Overlap with other Medicare Initiatives. In conjunction with the HRRP and HAC programs, the HVBP program is one prong of the approach that CMS is managing to try to improve hospital outcomes. Collectively the three programs will lead to hospitals being subject to a potential 6% reduction in Medicare payments (2% from HVBP beginning in 2017, 3% from HRRP and 1% for HAC). Measures are not fully coordinated between the programs. For example, the Agency for Healthcare Research and Quality Patient Safety 90 indicator is used for both the HVBP program and the HAC program. Rather than continuing to administer separate programs, the three could be combined into one program, similar to the Merit-based Incentive Payment System (MIPS) 8 that combines a variety of other initiatives for physicians. Due to the enabling legislation of these programs, such a change would most likely need to be enacted by Congress. This would allow CMS to better align all the quality and performance measures across programs so that hospitals are better-positioned to prioritize their efforts. CONCLUSION The HVBP program is an important effort by CMS to provide tangible incentives to hospitals to improve the quality of care that they are delivering. Current results show uneven performance both geographically and by different types of hospitals. To improve the program CMS should address four concerns. First, CMS should empirically evaluate whether the HVBP penalties are large enough that they lead to providers making changes across any of the four domains. Second, CMS should structure quality measures so that only meaningful differences in performance lead to meaningful differences in payments. Third, to decrease measurement volatility, CMS should increase the minimum number of cases for each of the metrics and could create an alternative HVBP program for low-case volume hospitals. Finally, Congress should consider combining the HVBP program with the readmission and hospital-acquired condition reduction programs so that CMS can better align measures across the programs. ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT 5
7 1. Centers for Medicare & Medicaid Services. Hospital Value-Based Purchasing Program Overview [cited 2015 Nov 12]. Available from: 2. Centers for Medicare & Medicaid Services. Readmissions-Reduction-Program [cited 2015 Nov 12]. Available from: 3. Centers for Medicare & Medicaid Services C for. Hospital-Acquired Condition (HAC) Reduction Program [cited 2015 Nov 12]. Available from: Reduction-Program.html 4. Centers for Medicare & Medicaid Services. Fiscal Year (FY) 2016 Results for the CMS Hospital Value-Based Purchasing Program [cited 2015 Nov 12]. Available from: 5. Tourison C. National Provider Call: Hospital Value-Based Purchasing (VBP) Program Apr 29 [cited 2015 Nov 12]. Available from: 6. QualityNet. Scoring: Hospital Value-Based Purchasing (HVBP). [cited 2015 Nov 12]. Available from: dcs/contentserver?c=page&pagename=qnetpublic%2fpage%2fqnettier3&cid= Centers for Medicare & Medicaid Services. Patient Experience of Care domain. [cited 2015 Nov 12]. Available from: Conway PH, Gronniger T, Pham H, Goodrich K, Bassano A, Sharp J, et al. MACRA: New Opportunities For Medicare Providers Through Innovative Payment Systems (Updated). Health Affairs [cited 2015 Nov 12]. Available from: org/blog/2015/09/28/macra-new-opportunities-for-medicare-providers-through-innovative-payment-systems-3/ ASSESSMENT OF THE HOSPITAL VALUE-BASED PURCHASING PROGRAM: CURRENT RESULTS AND OPPORTUNITIES FOR IMPROVEMENT 6
8 LeavittPartners.com 2015 Leavitt Partners, LLC
Linking Quality to Payment
Linking Quality to Payment Background Our nation s health care delivery system is undergoing a major transformation as reimbursement moves from a volume-based methodology to one based on value and quality.
More informationChapter Seven Value-based Purchasing
Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It
More informationHOSPITAL VALUE- BASED PURCHASING. Initial Results Show Modest Effects on Medicare Payments and No Apparent Change in Quality-of- Care Trends
United States Government Accountability Office Report to Congressional Committees October 2015 HOSPITAL VALUE- BASED PURCHASING Initial Results Show Modest Effects on Medicare Payments and No Apparent
More informationImproving Hospital Performance
Improving Hospital Performance Background AHA View Putting patients first ensuring their care is centered on the individual, rooted in best practices and utilizes the latest evidence-based medicine is
More informationHospital Value-Based Purchasing (VBP) Program
Medicare Spending per Beneficiary (MSPB) Measure Presentation Question & Answer Transcript Moderator: Bethany Wheeler, BS Hospital VBP Program Support Contract Lead Hospital Inpatient Value, Incentives,
More informationHCAHPS and Hospital Value-Based Purchasing (Hospital VBP)
Agency for Healthcare Research and Quality Advancing Excellence in Health Care www.ahrq.gov HCAHPS and Hospital Value-Based Purchasing (Hospital VBP) Agency for Healthcare Research and Quality Centers
More informationMedicare Value-Based Purchasing Programs
By Jane Hyatt Thorpe and Chris Weiser Background Medicare Value-Based Purchasing Programs To improve the quality of health care delivered to Medicare beneficiaries, the Centers for Medicare and Medicaid
More informationValue-Based Purchasing for Critical Access Hospitals
Value-Based Purchasing for Critical Access Hospitals Jane F. Jerzak, RN, CPA Partner, WIPFLI August 2015 Value-Based Purchasing Concepts for Critical Access Hospitals (CAHs) Objective of the Discussion:
More informationwhat value-based purchasing means to your hospital
Paul Shoemaker what value-based purchasing means to your hospital CMS has devised an intricate way to measure a hospital s quality of care to determine whether the hospital qualifies for incentive payments
More informationMIPS Performance Scoring: Understanding How CMS Proposes to Calculate Performance Is Key to Preparing for MIPS Participation
MIPS Performance Scoring: Understanding How CMS Proposes to Calculate Performance Is Key to Preparing for MIPS Participation By Robert F. Atlas, Lesley R. Yeung, and M. Brian Hall IV June 2016 On May 9,
More information5/19/2016 MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS. No Disclosures AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS
MIPS AND MACRA: MAKING SENSE OF THE NEW REGULATIONS AND PAYMENT SYSTEMS 1 No Disclosures 2 1 To Better Understand the Future.. We must remember the past regarding physician payment. 3 THE SGR SGR=Sustainable
More informationUnder Medicare s value-based purchasing (VBP) program,
RESEARCH HCAHPS survey results: Impact of severity of illness on hospitals performance on HCAHPS survey results James I. Merlino, MD, FACS, FASCRS a, Carmen Kestranek b, Daniel Bokar b, Zhiyuan Sun, MS,
More informationSummary of Major Provisions in Final House Reform Package
SPECIAL BULLETIN Monday, March 22, 2010 This summary is five pages. Summary of Major Provisions in Final House Reform Package The U.S. House of Representatives late yesterday voted to pass landmark health
More informationMedicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage
Medicare Design Part A: Inpatient care, hospice, and some home health care Part B: Physician services + outpatient care Part C ( Medicare Advantage ): Private plan alternative to Parts A and B Part D:
More informationMACRA Overview and RFI
MACRA Overview and RFI HIT Joint Committee October 6, 2015 Kate Goodrich, MD MHS Director, Quality Measurement and Valuebased Incentives Group CMS Medicare Access and CHIP Reauthorization Act (MACRA) The
More informationTHE LANDSCAPE OF MEDICAID ALTERNATIVE PAYMENT MODELS
POLICY BRIEF September 2014 THE LANDSCAPE OF MEDICAID ALTERNATIVE PAYMENT MODELS Authored by: America s Essential Hospitals staff KEY FINDINGS States have increasingly sought to establish alternative payment
More informationCMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM
For Immediate Release: Friday, January 07, 2011 Contact: CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM OVERVIEW: Today the Centers for Medicare
More informationEverything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask
Everything you ever wanted to know about Value-Based Purchasing* *But were afraid to ask TAHFM - April 10, 2013 John Murray, MBA Director, Patient Experience Deric Hebert Director, Engineering Services
More informationUpdates on CMS Quality, Value and Public Reporting
Updates on CMS Quality, Value and Public Reporting Federation of American Hospitals Policy Conference Kate Goodrich, MD MHS Director, Quality Measurement and Value Based Incentives Group, CMS June 17,
More informationFiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)
Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and
More informationTHE EVOLUTION OF CMS PAYMENT MODELS
THE EVOLUTION OF CMS PAYMENT MODELS December 3, 2015 Dayton Benway, Principal AGENDA Legislative Background Payment Model Categories Life Cycle The Models LEGISLATIVE BACKGROUND Medicare Modernization
More informationThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Summary of SGR Repeal and Replacement Provisions
ACOG Government Affairs May 2015 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Summary of SGR Repeal and Replacement Provisions This landmark bipartisan legislation, signed into law
More informationValue-Based Purchasing
Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based
More informationDecoding Medicare Spending Per Beneficiary (MSPB) Management and Physician Opportunities Together
Decoding Medicare Spending Per Beneficiary (MSPB) Management and Physician Opportunities Together Dale N. Schumacher THE TRANSFORMATION TO CONSUMER-DRIVEN HEALTHCARE Decoding Medicare Spending Per Beneficiary
More informationThe Strategic Way to Manage Healthcare Performance Data analytics and benchmarking
The Strategic Way to Manage Healthcare Performance Data analytics and benchmarking Value Based Purchasing Begins in 2016 Will You Be Ready? Chris Attaya VP of Business Intelligence, Strategic Healthcare
More informationAre Electronic Medical Records Worth the Costs of Implementation?
Research Are Electronic Medical Records Worth the Costs of Implementation? TARA O'NEILL AUGUST 6, 2015 Executive Summary Electronic medical records (EMRs), as a cornerstone of a more intelligent, adaptive,
More informationFrom Quantity To Quality
From Quantity To Quality Value Based Reimbursement By CMS Copyright 2015 LifeLinc Corporation www.lifelinc.com From Quantity To Quality: Value Based Reimbursement By CMS Written by Brandon Herrington,
More informationHome Health Value-Based Purchasing. April 6, 2016 12:00-3:45 pm
Home Health Value-Based Purchasing April 6, 2016 12:00-3:45 pm Learning Objectives Understand the changing health care landscape, including various models of value-based purchasing Learn how the HHVBP
More informationOVERALL IMPLEMENTATION CONSIDERATIONS
Donald Berwick, M.D., M.P.H. Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Avenue, S.W., Room 445-G Washington,
More informationJune 22, 2012. Dear Administrator Tavenner:
Submitted Electronically Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue
More informationSustainable Growth Rate (SGR) Repeal and Replace: Comparison of 2014 and 2015 Legislation
Sustainable Growth Rate (SGR) Repeal and Replace: Comparison of 2014 and 2015 Legislation Proposal 113 th Congress - - H.R.4015/S.2000 114 th Congress - - H.R.1470 SGR Repeal and Annual Updates General
More informationAdding Value to. Provider Compensation. June 13, 2016. Healthcare Strategy Group OHA Presentation 2016. Adding Value to. Physician Compensation
Provider Compensation June 13, 2016 1 Who are We? About (HSG) Hospital-physician integration specialists since 1999 Strategic, best practice approach to employed physician networks and independent physician
More informationMedicare Skilled Nursing Facility Prospective Payment System
Medicare Skilled Nursing Facility Prospective Payment System Payment Rule Brief FINAL RULE Program Year: FFY 2016 Overview and Resources On August 4, 2015, the Centers for Medicare and Medicaid Services
More informationCMS Vision for Quality Measurement and Public Reporting
CMS Vision for Quality Measurement and Public Reporting Annual Policy Conference Federation of American Hospitals Kate Goodrich, M.D., M.H.S. Quality Measurement & Health Assessment Group, Center for Clinical
More informationMount Sinai Care: A Medicare Shared Savings Program Primer. Brett Bernstein, MD, AGAF, FASGE Medical Director, Provider Partners of Mount Sinai IPA
Mount Sinai Care: A Medicare Shared Savings Program Primer Brett Bernstein, MD, AGAF, FASGE Medical Director, Provider Partners of Mount Sinai IPA Mount Sinai Health System Network Mount Sinai Health System
More informationMedicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich
Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich Medicare s new hospital inpatient value-based purchasing ( VBP ) program, mandated by the Affordable
More informationFY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Proposed Rule
June 24, 2015 Andrew Slavitt Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Attention: CMS- 1629-P, Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850
More informationWHITE PAPER February 2016. Realizing the Promise: Overcoming the Barriers to ACO Success
WHITE PAPER February 2016 Realizing the Promise: Overcoming the Barriers to ACO Success OVERVIEW The Accountable Care Organizations (ACOs) brought to reality by the Affordable Care Act were designed with
More informationSynchronizing Medicare policy across payment models
C h a p t e r1 Synchronizing Medicare policy across payment models C H A P T E R 1 Synchronizing Medicare policy across payment models Chapter summary In this chapter Historically, Medicare has had two
More informationInpatient Facility Reimbursement. February 12, 2014
Inpatient Facility Reimbursement February 12, 2014 3014 HealthChoice Inpatient Background On 10/01/07, HealthChoice implemented Medicare Severity Diagnosis Related Groups (MS-DRGs) and changed the outlier
More informationRepeal the Sustainable Growth Rate (SGR), avoiding annual double digit payment cuts;
Background Summary of H.R. 2: The Medicare Access and CHIP Reauthorization Act of 2015 SGR Reform Law Enacts Payment Reforms to Improve Quality, Outcomes, and Cost On April 16, 2015, the President signed
More informationSGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation
SGR Repeal and Medicare Provider Payment Modernization Act of 2015: Timeline of Implementation 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026+ Base Update Jan Jun: 0 July- Dec: 0.5 0.5% 0.5%
More informationCMS Listening Session: Merit-Based Incentive Payment System (MIPS)
CMS Listening Session: Merit-Based Incentive Payment System (MIPS) Kate Goodrich, MD, MHS, Director, Center for Clinical Standards and Quality Pierre Yong, MD, MPH, MS, Acting Director, Quality Measurement
More informationMeeting of the Advisory Panel on Outreach and Education (APOE) Centers for Medicare and Medicaid Services March 27, 2013.
701 Pennsylvania Avenue, Ste. 800 Washington, DC 20004 2654 Tel: 202 783 8700 Fax: 202 783 8750 www.advamed.org Meeting of the Advisory Panel on Outreach and Education (APOE) Centers for Medicare and Medicaid
More informationNarrow network health plans: New approaches to regulating adequacy and transparency. Michael S. Adelberg
Compliance TODAY October 2015 a publication of the health care compliance association www.hcca-info.org Combating healthcare fraud in New Jersey an interview with Paul J. Fishman United States Attorney
More informationThe ABCs of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
The ABCs of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Medicare Access and CHIP Reauthorization Act (MACRA) Repeals the Sustainable Growth Rate Moves to a payment system based on
More informationKey Information. QP or Partial QP Determination
HIMSS MACRA NPRM Fact Sheet Alternative Payment Models: Qualifying Alternative Payment Model Participant & Partial Qualifying Alternative Payment Model Participant Determination Key Information During
More informationChanges for Calendar Year 2015 Physician Quality Programs and Other Programs in the Medicare Physician Fee Schedule
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 FACT SHEET FOR IMMEDIATE RELEASE October 31, 2014 Contact: CMS
More informationHAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE
HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE Cepheid s Government Affairs Department Advocating for Patient Access to Molecular Diagnostics in the Era of Healthcare Reform A TEAM APPROACH Legislative
More informationWhat Value Are We Gaining from Value-Based Purchasing?
WHITE PAPER: What Value Are We Gaining from Value-Based Purchasing? Authors: Brooke Palkie, EdD, RHIA and David Marc, MBA, CHDA Copyright 2015 Panacea Healthcare Solutions, Inc. All Rights Reserved Executive
More informationRefining the hospital readmissions reduction program
Refining the hospital readmissions reduction program C h a p t e r4 C H A P T E R 4 Refining the hospital readmissions reduction program Chapter summary In this chapter In 2008, the Commission reported
More informationHospital Value-based Purchasing Specifications 2016 Updated August 2015
Description Methodology Measurement Period Allowable Exclusions Total Performance Score Individual measures CMS incentive program for PPS hospitals. The purpose is to achieve value by tying payment to
More informationQuality Provisions Ordered by Implementation Date
1 3006, 10301 2 1311 3 3006, 10301 by Secretary 10/1/2011 Ambulatory Surgery Centers 10/1/2011 Providers in HBE shall be accredited with respect to local performance on clinical quality measures (e.g.,
More informationHCAHPS and Value-Based Purchasing Methods and Measurement. Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services
HCAHPS and Value-Based Purchasing Methods and Measurement Deb Stargardt, Improvement Services Darrel Shanbour, Consulting Services Today s Learning Objectives Acquire new knowledge pertaining to: A. Hospital
More information$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ HEALTHCARE REVENUE CYCLE MANAGEMENT TRENDS IN ALTERNATIVE PAYMENT MODEL ADOPTION
RESEARCH AND REPORT BY $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ HEALTHCARE REVENUE CYCLE MANAGEMENT TRENDS IN ALTERNATIVE PAYMENT
More informationSynchronizing Medicare policy across payment models
Synchronizing Medicare policy across payment models C h a p t e r1 C H A P T E R 1 Synchronizing Medicare policy across payment models Chapter summary In this chapter Historically, Medicare has had two
More informationAdvancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule. May 26, 2015 // 12:00 P.M. 1:00 P.M. EST
Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule May 26, 2015 // 12:00 P.M. 1:00 P.M. EST Center For Industry Transformation The DHG Healthcare Center for Industry Transformation
More informationMarch 28, 2016. Dear Acting Administrator Slavitt:
March 28, 2016 Andrew Slavitt, Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1644-P P.O. Box 8013 Baltimore, MD 21244 8013 Re: Medicare
More informationMIPS. ACR Issues Analysis of Proposed MACRA MIPS Rule
ACR Issues Analysis of Proposed MACRA MIPS Rule The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-5517-P) on April 27, 2016, to establish many of the provisions of Medicare
More information1. Would additional health care organizations be interested in applying to the Pioneer ACO Model? Why or why not?
February 28, 2014 Re: Request for Information on the Evolution of ACO Initiatives at CMS AMGA represents multi specialty medical groups and other organized systems of care, including some of the nation
More informationTHE USE OF TECHNOLOGY TO IMPROVE QUALITY AND REDUCE COSTS FOR HOSPITALS IN GEORGIA
THE USE OF TECHNOLOGY TO IMPROVE QUALITY AND REDUCE COSTS FOR HOSPITALS IN GEORGIA Health Policy and Management Capstone Project Spring 2014 2 Index I. Introduction II. III. IV. Description of Hospitals
More informationTHE NEW COSTS OF UNIONIZATION
THE NEW COSTS OF UNIONIZATION THE NEW COSTS OF UNIONIZATION IN HEALTHCARE UNION ELECTIONS AND REPRESENTATION: LOWER HCAHPS SCORES AND INCREASE READMISSION RATES New Research Demonstrates Significant Financial
More informationPatient Experience/ Satisfaction What s at Stake? Customer Service at UAMS
Patient Experience/ Satisfaction What s at Stake? Customer Service at UAMS Why Do We Care? We started measuring patient satisfaction about 11 years ago because we care what our patients are saying. We
More informationValue-Based Payment and Health System Transformation
Value-Based Payment and Health System Transformation National Health Policy Forum Patrick Conway, M.D., MSc CMS Chief Medical Officer Deputy Administrator for Innovation and Quality Director, Center for
More informationMEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY
MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT (MACRA) MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) ADVANCING CARE INFORMATION PERFORMANCE CATEGORY SUMMARY OF PROVISIONS Brief Synopsis MACRA sunsets the Electronic
More informationPYA. PYALeadership Briefing. Beyond Tactics: Building a Value-Based Culture
PYA PYALeadership Briefing Beyond Tactics: Building a Value-Based Culture May 2012 Beyond Tactics: Building a Value-Based Culture Perhaps because CMS launched the Hospital Compare website over five years
More informationHealthcare Reform & Value Based Purchasing: Are You Ready?
Healthcare Reform & Value Based Purchasing: Are You Ready? Premier, Inc Jan Englert, Director-QUEST Poudre Valley Health System Sonja Wulff, VP Center for Performance Excellence Federal Register Statement:
More informationA Study by the National Association of Urban Hospitals September 2012
The Potential Impact of the Affordable Care Act on Urban Safety-Net Hospitals A Study by the National Association of Urban Hospitals September 2012 Introduction One by one and provision by provision, the
More informationPost-Acute/Long- Term Care Planning for Accountable Care Organizations
White Paper Post-Acute/Long- Term Care Planning for Accountable Care Organizations SCORE A Model for Using Incremental Strategic Positioning as a Planning Tool for Participation in Future Healthcare Integrated
More informationGetting to value in high-value health care
+ Getting to value in high-value health care Ashish K. Jha, MD, MPH December 4 th, 2015 @ashishkjha + We have a value problem 1 + Value= Quality Costs + Quality is suboptimal 1 in 4 seniors injured during
More informationValue Based Purchasing: New Tools for Hospitals
Value Based Purchasing: New Tools for Hospitals The Value Based Purchasing Score Estimator & HANYS Quality Reports Overview of CMS Value Based Purchasing Program Brian Potter, Vice-President, Finance &
More informationMedicare Access and CHIP Reauthorization Act of 2015 Merit-Based Incentive Payment System and Alternative Payment Model Provisions
Medicare Access and CHIP Reauthorization Act of 2015 Merit-Based Incentive Payment System and Alternative Payment Model Provisions Department of Health & Human Services Centers for Medicare & Medicaid
More informationOverview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017
Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Bethany Wheeler Hospital VBP Program Support Contract Lead HSAG February 17, 2015 2 p.m. ET Purpose This event will provide an
More informationData Shows Reduction in Medicare Hospital Readmission Rates During 2012
Medicare & Medicaid Research Review 2013: Volume 3, Number 2 A publication of the Centers for Medicare & Medicaid Services, Office of Information Products & Data Analytics Data Shows Reduction in Medicare
More informationAccountable Care Organization Refinement Brief
Accountable Care Organization Refinement Brief The participants in the Medicare Shared Savings Program (MSSP), the Physician Group Practice Transition Demonstration (PGP-TD), and the Pioneer Accountable
More informationNursing Home Compare Five-Star Quality Rating System: Year Five Report [Public Version]
Nursing Home Compare Five-Star Quality Rating System: Year Five Report [Public Version] Final Report June 16, 2014 Prepared for Centers for Medicare & Medicaid Services (CMS) AGG/Research Contracts & Grants
More informationMedical Billing, Patient Centered Outcomes and Health Care Competitiveness
+ Today s Patient Centered Outcomes Seminar Getting to patient-centered high value healthcare Is the ACA enough? Ashish Jha, MD, MPH Professor of Health Policy and Management, Harvard School of Public
More informationHealth IT Policy Committee Meeting. Data Update. March 10, 2015
Health IT Policy Committee Meeting Data Update March 10, 2015 Agenda Examine characteristics associated with meaningful use performance among eligible hospitals Care transitions Patient engagement Patient
More informationPOLICY BRIEF. Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? October 2015. rhrc.umn.edu
POLICY BRIEF October 2015 Which Rural and Urban Hospitals Have Received Readmission Penalties Over Time? Peiyin Hung, MSPH Michelle Casey, MS Ira Moscovice, PhD Key Findings Over the first three years
More informationMACRA: Medicare's Shift to Value-based Delivery & Payment Models. Presented by Amy Mullins, MD, CPE, FAAFP
MACRA: Medicare's Shift to Value-based Delivery & Payment Models Presented by Amy Mullins, MD, CPE, FAAFP Current State Over Utilization Volume over Value Fee for Service Silos of Care 2 Push Toward Value
More informationPhysician Scorecards. Clinical Documentation and Coding Improvement. Team Goals Metrics. Data Benchmarks Compliance.
Health Solutions Clinical Documentation and Coding Improvement Physician Scorecards Individual physician performance has a direct impact on a health system s financial, patient safety, and care quality
More informationValue-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012
Value-Based Purchasing Program Overview Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Presentation Overview Background and Introduction Inpatient Quality Reporting Program Value-Based
More informationCMS is requesting information to aid in the planning and implementation of the MIPS in the following areas:
Summary of Medicare s Request for Information on the Provisions in MACRA which Allow for Implementation of Alternative Payment Models and a Merit-Based Incentive Payment System On September 28, 2015, the
More informationFunding for Clinical Services in Academic Departments in the World of ACOs and Health Care Reform
Funding for Clinical Services in Academic Departments in the World of ACOs and Health Care Reform 2015 Association of Professors of Dermatology Annual Meeting Atul Grover, M.D., Ph.D. Chief Public Policy
More informationIncentive Compensation Systems In Community Health Centers. Curt Degenfelder Managing Director curtis.degenfelder@rsmi.com
Incentive Compensation Systems In Community Health Centers Curt Degenfelder Managing Director curtis.degenfelder@rsmi.com 1 What are the components of successful health centers culture that support an
More informationValue Based Care and Healthcare Reform
Value Based Care and Healthcare Reform Dimensions in Cardiac Care November, 2014 Jacqueline Matthews, RN, MS Senior Director, Quality Reporting & Reform Quality and Patient Safety Institute Cleveland Clinic
More informationPresident Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012--
President Obama Signs the Temporary Payroll Tax Cut Continuation Act of 2011 --New Law Includes Physician Update Fix through February 2012-- On Friday, December 23, 2011, President Obama signed into law
More informationPL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems
PL 111-148 and Amendments: Impact on Post-Acute Care for Health Care Systems By Kathleen M. Griffin, PhD. There are three key provisions of the law that will have direct impact on post-acute care needs
More informationThe Promise of Regional Data Aggregation
The Promise of Regional Data Aggregation Lessons Learned by the Robert Wood Johnson Foundation s National Program Office for Aligning Forces for Quality 1 Background Measuring and reporting the quality
More informationUNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM: FINANCIAL REPORT AND SYSTEM DASHBOARDS May 29, 2013
UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM: FINANCIAL REPORT AND SYSTEM DASHBOARDS May 29, 2013 Office of the Vice President for Health Affairs Board of Trustees Spring Chicago Meeting UI
More informationA MACRA Overview. A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC
A MACRA Overview A web discussion with guests Ivy Baer, Gayle Lee, and Tanvi Mehta of AAMC An Affinity Group Brought to you by HFMA and Vizient Sponsored by Kaufman Hall June 6, 2016 Meeting Notes Plan
More informationOils. Heart-Healthy CONFERENCE ISSUE. American Heart Month. The Newest Trends in the Dairy-Free Aisle. Plan Healthful Vegan Diets
CONFERENCE ISSUE Vol. 17 No. 2 February 2015 The Magazine for Nutrition Professionals Heart-Healthy Oils Learn about the latest varieties and science on the healthful fats they contain. American Heart
More informationMedicare Advantage Star Ratings: Detaching Pay from Performance Douglas Holtz- Eakin, Robert A. Book, & Michael Ramlet May 2012
Medicare Advantage Star Ratings: Detaching Pay from Performance Douglas Holtz- Eakin, Robert A. Book, & Michael Ramlet May 2012 EXECUTIVE SUMMARY Rewarding quality health plans is an admirable goal for
More informationMedicare Inpatient Rehabilitation Facility Prospective Payment System
Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief FINAL RULE Program Year: FFY 2014 Overview and Resources On August 6, 2013, the Centers for Medicare and Medicaid
More informationU.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health. A Permanent Solution to the SGR: The Time Is Now
U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health A Permanent Solution to the SGR: The Time Is Now January 21 & 22, 2015 Submitted Testimony regarding Standards of Care
More informationPROMISING PRACTICES IN HOME AND COMMUNITY-BASED SERVICES
PROMISING PRACTICES IN HOME AND COMMUNITY-BASED SERVICES Lessons Learned from Using a Health Information Technology Program that Combines Claims-Level Data with Service-Level Data Outcome data in the treatment
More informationOverall Hospital Quality Star Rating on Hospital Compare Launching April 2016. February 8, 2016/ 3:00-4:00 PM EST
Overall Hospital Quality Star Rating on Hospital Compare Launching April 2016 February 8, 2016/ 3:00-4:00 PM EST 1 Today s Presenter Melinda Hancock Partner, DHG Healthcare Leads a team in developing DHG
More informationHospital Financing Overview
Texas Hospital Association 1108 Lavaca, Suite 700, Austin, TX, 78701-2180 www.tha.org Hospital Financing Overview Under federal law, hospitals are required to provide care to anyone who seeks it in their
More informationTimeline for Health Care Reform
Patient Protection and Affordable Care Act (H.R. 3590) and the Reconciliation Bill (H.R. 4872) March 24, 2010 Color Code: Hospitals Insurance Coverage Other/Workforce Delivery System 2010 Expands the RAC
More informationArticle reprinted from Patient Safety & Quality Healthcare, July/August 2012 VALUE-BASED PURCHASING
Article reprinted from Patient Safety & Quality Healthcare, July/August 2012 VALUE-BASED PURCHASING Outperform the Competition: Hospital Value-Based Purchasing By Jeffrey Robbins JULY/AUGUST 2012 WWW.PSQH.COM
More information