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Hospital bonuses, penalties released for value-based purchasing

Saturday November 30, 2013
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The Centers for Medicare & Medicaid Services released the list of hospitals that will receive Medicare payment bonuses and penalties for fiscal year 2014 under the Value-Based Purchasing program, part of the Affordable Care Act.

In a blog post, Patrick Conway, MD, MSc, chief medical officer for CMS and director of the Centers for Clinical Standards and Quality, noted 1.25% of hospitals’ base-operating diagnosis-related group payments go into a value-based purchasing pool for FY 2014.

“Depending on how well hospitals measured up to their peers on important healthcare quality indicators during a prior performance period, they will either break even, get a bonus or — if their performance is lower than average — get back less than what they contributed to the FY 2014 pool,” Conway wrote.

About 1,300 hospitals, or slightly less than half those participating in the program, will essentially break even with a payment change of between 0.2% and minus-0.2%. Another 630 hospitals will receive a bonus, meaning an increase in Medicare payment of more than 0.2%. And 778 hospitals will receive a reduced payment of more than 0.2%.

Conway noted about a third of the higher-performing hospitals were not in that category in FY 2013, and the same can be said about approximately a quarter of the lower-performing hospitals. “The fact that not every higher-performing hospital last year made the grade this year, and not every lower-performing hospital last year will see payment decline this year, means that hospitals are adjusting to the new world of value-based payment.

“It also may mean that the important addition of 30-day mortality measures for heart attack, heart failure and pneumonia had an impact on hospitals’ scores.”

The 30-day mortality measures are among 24 measures used to determine a hospital’s VBP score for FY 2014.

Process measures (13)

• Acute myocardial infarction: Fibrinolytic therapy received within 30 minutes of hospital arrival; primary PCI received within 90 minutes of hospital arrival.

• Heart failure: Discharge instructions.

• Pneumonia: Blood cultures performed in the ED prior to initial antibiotic received in hospital; initial antibiotic selection for CAP in immunocompetent patient.

• Surgical care: Prophylactic antibiotic received within one hour prior to surgical incision; prophylactic antibiotic selection for surgical patients; prophylactic antibiotic discontinued within 24 hours after surgery end time; cardiac surgery patients with controlled 6 a.m. postoperative serum glucose; urinary catheter removed on postoperative days one or two; surgery patients on beta-blocker therapy prior to arrival who received a beta-blocker during the postoperative period; surgery patients with recommended venous thromboembolism prophylaxis ordered; surgery patients who received appropriate venous thromboembolism prophylaxes between 24 hours before surgery and 24 hours after surgery.

Patient experience of care (8)

Communication with nurses, communication with doctors, responsiveness of hospital staff, pain management, communication about medicines, cleanliness and quietness of hospital environment, discharge information, overall rating of hospital.

Outcome measures (3)

AMI 30-day mortality rate, HF 30-day mortality rate, pneumonia 30-day mortality rate.

FY 2014 results by hospital are available to download at: http://go.cms.gov/19IjBGp (in the downloads section).


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