I'm evasive because these matters are complicated and hard data is tough to get. It seemed even more befuddling after I asked a few wise people these questions, including some stalwart ACA boosters.
'A period of confusion'
All of them hedged, saying it's still too early for most of the new rules to have had an impact on quality. Providers are just beginning to figure out where they stand under the threat of penalties for higher rates of 30-day readmissions, hospital- acquired infections, and 30-day mortality, or for lower value-based purchasing process measures and patient experience scores.
The first VBP performance review period for payment that takes effect Oct. 1, 2012, doesn't end until March 31, the end of this month. And the first evaluation period for 30-day mortality rates, to be factored into the VBP formula for incentive payments starting Oct. 1, 2013, doesn't end until June 30, 2012. The first three-year performance period to determine penalties for excess readmissions ended June 30, 2011, but CMS has yet to release final scores. Hospitals are nervous, because they still may not be sure where they stand.
These ACA penalties for hospitals, you'll recall, could eventually total 6% of Medicare DRG payments for a hospital that performs the worst in all categories, a potentially devastating chunk of change for struggling facilities that depend on federal reimbursement for their survival.
"This is a period of confusion and shakeout for hospital leaders as they try and figure out how to be responsive," says Donald Goldmann, MD, an infectious disease practitioner at Children's Hospital Boston, and senior vice president of the Institute for Healthcare Improvement. "I honestly think it would be naive to expect any impact on actual outcomes in this period of time."