CMS issues final value-based purchasing rule

On April 29, 2011 The Centers for Medicare & Medicaid Services today issued a final rule (42 CFR Parts 422 and 480) that sets forth its policies for the hospital value-based purchasing program. Under the Patient Protection and Affordable Care Act, the VBP program will pay hospitals based on their actual performance on quality measures, rather than just the reporting of those measures, beginning in fiscal year 2013. In the first year, the VBP program will include 12 clinical quality measures as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experiences with care survey.

The clinical measures will account for 70% of a hospital’s VBP score and the HCAHPS survey for 30%. For FY 2014, CMS will add the heart attack, heart failure and pneumonia mortality measures to the VBP program, as well as eight measures of hospital-acquired conditions and two composite patient safety and inpatient quality indicators developed by the Agency for Healthcare Research and Quality. The VBP program will apply to all acute-care prospective payment system hospitals with certain exceptions. For example, for the clinical process measures, CMS will exclude from hospitals’ scores any measures for which they report fewer than 10 cases and will exclude from the VBP program any hospitals for which fewer than four of the 12 proposed clinical process measures apply. CMS will also exclude from the VBP program any hospital that reports fewer than 100 HCAHPS surveys during the performance period.

For the FY 2013 incentive payments, CMS proposes that it will use data associated with hospital discharges from the third and fourth quarters of 2011 and the first quarter of FY 2012, as the “performance period” for the proposed clinical process of care and HCAHPS measures. So starting July 1, 2011 and running to March 31, 2012, our scores for “Room and restroom always clean” will be very, very important. All your hard work improving your scores will now be validated.

A hospital’s performance on each measure during the performance period will be compared with a “baseline period” from July 1, 2009 to March 31, 2010. Whether the hospital receives a value-based incentive payment, and the amount of such payment, will be based on either how well the hospital performs on the specified quality measures during the performance period or how much the hospital’s performance improves on the quality measures from its performance during the baseline period. The higher a hospital’s achievement or improvement during the performance period, the higher the hospital’s value-based incentive payment.

Do you know what your HCAHPS scores were July 1, 2009 to March 31, 2010? If you have been tracking and working on your performance good for you. If not, well, I’m sure you will be now. You should already have a spreadsheet setup for doing your own comparison and tracking.

In upcoming posts I will be writing about steps you can take to improve your scores and staff performance. Go HCAHPS!