CMS Releases Value-Based Purchasing Incentive Plan

Cheryl Clark, for HealthLeaders Media , January 11, 2011

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.

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3 comments on "CMS Releases Value-Based Purchasing Incentive Plan"

reesie22 (7/18/2011 at 4:05 PM)
Let's pay Presidents, Senators, Congressmen, and GOVERNMENT WORKERS based on their satisfaction survey scores. ....oh....oh....oh...wait a minute...maybe it's not such a great idea now right? I agree with the first poster who tells how liberalism has cultivated a citizenry of entitlement demanders who think their laptops, cell phones, internet access, college, housing, food, and health care are all RIGHTS and should be provided for free for them (but somebody else is paying...ME!). All the while they're using money to pay for manicures, pedicures, hair pieces, tattoos, clubbing, alcohol, ipods, and music...but they don't want to pay for the above-mentioned priorities. Change our society from liberalism entitlement mentality to conservative self-responsibility!!!

Karen Thomas (1/18/2011 at 12:22 PM)
There MUST be a better measure to look at for determining how much money should be given or not given to a health care entity. Customer Satisfaction scores vary regionally, as well as within regions and communities near each other. I work and live in a community that is rural, poor, minority and I have experienced the general population here as feeling very entitled to get whatever they can from the "system". Part of that system is the local hospital. One can give great care: be courteous, professional, friendly, knowledgeable, skilled, but turn away a visitor for age requirement or don't feed the entire stock of nourishments to a pt/family group and they turn sour and file a complaint. They can say to your face they are happy with your care, then send in a survey that says otherwise. Leaders in this facility have worked on this customer satisfaction issue very hard for the last several years, and we seem to be chasing our tails. Don't punish us by taking away pay for the work we do. Thank you

Arun K.Potdar (1/12/2011 at 2:41 PM)
On the surface it appears to be a win ,win situations for all parties involved except the double jeopardy issue. However, it is not clear yet how this scenario is going to get played out from hospitals' point of view. Clinical and Patient related Information highways are not up to the marks in many hospitals and this is more so in the Community Based Hospitals. It is not just the cost of IT but also lack of incentives to caregivers to become experts in EMR and EHR usage. Physicians are main road blocks in this area and in general, shortage of Care Givers and IT workers makes it very difficult to use new technology. The patient care pressure at work and additional costs associated with the data conversions has in past led to communication breakdowns and that has led to errors such as patients getting lost in the shuffles to medication errors. Second concern is the collection of accurate data and transferring it to the CMS computers. Those who have worked on the Hospital Cost Reports will understand how painful it is to get Work Sheet "S" (Statistical information) information from the Hospital's IT databases. I suspect, CMS may add one more Worksheet to S series to collect data associated to various benchmarks set for determining the winners and losers in this game. Hope fully, costs associated with this initiative has been assessed by someone in the industry and it will be a worth while to see what that number is likely to be. Hospitals can't even get their CDM dictionaries cleaned up to reduce billing errors then how this massive data collection, scrubbing and analyzing necessary to develop decision support systems will be accomplished is a Million Dollar Question.




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