Federal officials have issued a long-awaited proposal on how they will make value-based purchasing incentives. The document sets forth which metrics will generate payment after Oct. 1, 2012.
The Centers for Medicare & Medicaid Services proposal, issued late Friday, incorporates 17 clinical process-of-care measures used in five health categories, acute myocardial infarction, heart failure, pneumonia, healthcare associated infections and surgical care improvement. It also will use eight measures from the hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that reflects how patients view their care experiences.
Those measures include patients' views of their communication with nurses and doctors, the responsiveness of hospital staff, their pain management and the cleanliness and quietness of the hospital environment.
These 25 measures will be used to generate FY 2013 DRG payments.
By 2014, it will add mortality outcome measures for the three health conditions, eight hospital-acquired condition measures and nine Agency for Healthcare Research and Quality measures. The hospital-acquired condition measures include surgical foreign object retention, air embolism, blood incompatibility, pressure ulcer stages III and IV, falls and trauma such as burns or electrical shocks, catheter-associated urinary tract infections and manifestations of poor glycemic control.
The regulations will apply to discharges at 3,000 acute care hospitals. All these hospitals will have their funding reduced starting with 1% in fiscal year 2013, rising to 2% by FY 2017, but will have a chance to earn that money back, and perhaps more, under the incentives algorithm.
Algorithms will be calculated to derive a Total Performance Score or TPS for each hospital.
CMS director Don Berwick, in a statement, called the proposed regulations "a huge leap forward in improving the quality and safety of America's hospitals for both Medicare beneficiaries and all Americans.