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From Health Law Daily, October 27, 2015

CMS: 1,800 hospitals to receive payment increases under value-based purchasing program

By Mary Damitio, J.D.

The results are in for the 2016 Hospital Value-Based Purchasing Program (VBP Program) and 1,800 hospitals will be receiving positive payment adjustments based on the quality of care that they provided to their patients. CMS announced the results of the VBP Program, which is in the fourth year of value-based purchasing for the largest share of Medicare spending that affects payments for inpatient stays in over 3,000 hospitals.

ACA. Section 3001 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) established the VBP Program, which adjusts the amount that CMS pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care that is given to patients. CMS will pay hospitals more or less for each Medicare fee-for-service discharge depending how well the hospitals performed as compared with others on health care quality measures and how much the hospitals have improved over time.

Quality measures. CMS has been increasing the number of quality domains and measures that are used to evaluate performance, with the goal of including a “broader, richer” set of measures that align with the National Quality Strategy (NQS). For FY 2016, the hospitals’ total performance scores were based on clinical process of care, patient experience, outcome, and efficiency. The hospitals also had a domain score for at least two of four domains, and received an improvement or an achievement score.

FY 2016 results. CMS reported that 1,800 hospitals will see a positive change in their base operating Medicare Severity diagnosis-related group (MS-DRG) payments, and about half of hospitals will see only a small change to their payments (between -0.4 and 0.4 percent). The highest performing hospital will receive over a three percent net change in its payment amount, and the worse performing hospital will receive a reduction of 1.75 percent and will not receive an incentive payment.

Future policies. CMS has also set forth policies that will modify the 2017 and 2018 VBP Program. For example, in 2017, CMS will add two new safety measures, a clinical care process measure, a central-line associated bloodstream infection measure, and will remove six, “topped-out” clinical process measures. In 2018, CMS will include clinical care, patient experience, and caregiver centered experience/care coordination, safety, and efficiency and cost reduction measures.

MainStory: TopStory AgencyNews IPPSNews CMSNews PartANews QualityNews

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