And by the way, the first performance payments—some might call them penalties for poor performance—will be reflected in federal reimbursement checks effective for patients discharged as of October 1. Hospitals will soon found out how they did for the first performance period, which began July 1, 2011 and ended on March 31, and whether they'll be rewarded from the $850 million pool.
30-Day Window 'Completely Arbitrary'
By October 1, 2014, the VBP formula will begin giving some weight to 30-day mortality measures. How much remains to be seen.
Clyde Yancy, MD, chief of cardiology at Northwestern University and former president of the American Heart Association, agrees with Fonarow, saying "there are in fact, probably a better collection of process measures that should be incorporated."
But he takes things one step further, questioning the reliance on 30-day mortality as a sharp cut-off for what constitutes better care.
"Thirty days is completely arbitrary," he says. "And it concerns me that so many systems, so many practitioners, are managing for the 30-day window...It's causing us, I think, to make some unwise decisions in the way we allocate our own internal resources, equipping hospitals with transition of care coordinators and nurse managers and a whole field of personnel to focus with high intensity care from discharge day zero to day 30.
Yancy emphasizes that while there is some data that the process measures in use improve outcomes, such as reducing mortality or readmissions, the window of time that improvement is seen isn't usually 30 days; it may be more like 90 days, or six months or a year.
"Well what happens on day 31?" he asks. "What it will require is more of a longitudinal commitment, to improve outcomes for patients so they are free of the need and the burden of rehospitalization."