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Value based purchasing effect on ID physicians
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The Medicare hospital inpatient Value-Based Purchasing program, or VBP, is the result of the 2010 Affordable Care Act, which mandates that the CMS create and implement a pay-for-performance program for acute care hospitals to be paid by the inpatient Prospective Payment System, or IPPS.
Molly Tims
Keith S. Kaye
VBP correlates Medicare payment to the quality and performance of hospitals through monetary incentives and penalties. IPPS payments will be reduced by 1% in federal fiscal year (FFY) 2013 (beginning Oct. 1, 2012), and up to 2% by the FFY 2017. These reduced IPPS payments will be redistributed to hospitals based on their performance (data collected between July 2011 and March 2012) in comparison to a standardized national benchmark (calculated from the July 1, 2009, to March 31, 2010, baseline performance period). Changes in payments will begin in October 2012.
The quality measurements include clinical processes of care, patient experiences of care, patient outcomes and health care efficiency. According to CMS, the aim of VBP is to improve “patient outcomes, quality, safety and lower costs with Medicare payment” by making hospitals more fiscally responsible for the quality of patient care that they deliver. This national quality strategy seeks to create a competitive and constantly improving national scale of standards while revamping Medicare finances to deliver better outcomes at lower costs. Additional new policies, improvements and measures will likely be added to VBP in FFYs 2015, 2016 and 2017.
The fine print
Hospitals are scored based on 12 measures for clinical process of care and eight measures for patient experience. The FFY 2014 program will add three outcome mortality measures and the hospital-acquired conditions (HAC) measures set, including two hospital-acquired infection measures.
CMS will calculate an achievement score and improvement score for each hospital based on its compliance and quality of care provided as determined by the CMS performance measures. The national benchmark standard created by CMS represents the highest achievement level a hospital can obtain (a perfect score), whereas the threshold represents the minimum level of acceptable achievement. Once a hospital reports the appropriate data for each process, CMS will create an achievement score and an improvement score. The overall VBP score for each hospital will determine how much money they will receive from the VBP incentive pool based on a linear exchange function that ranks hospitals compared with the national average and CMS-determined standards. Hospitals will receive payment adjustments under the VBP program that, depending on their score compared with the national average, can result in earning more, less or the same amount as their IPPS payment reduction (ie, 1% in FFY 2013). The VBP payback could range from about 60% to about 160% of the original withheld reduction.
Under the microscope
Optimizing the prevention and management of infectious diseases will be a crucial determinant for a hospital to obtain favorable VBP scores. VBP targets processes of care, preventable HACs and hospital complications.
For 2013, there are several metrics that fall under the domain of infectious diseases, including: management of CAP; prevention of SSI; and in FY 2014, prevention of vascular catheter-associated infections; and catheter-associated urinary tract infection (CAUTI).
Thus, hospital management will increasingly rely on infection control and antimicrobial stewardship departments, as well as infectious disease physicians, to optimize VBP scores regarding these infection-related metrics. Not only will the VBP program aim to improve patient safety, satisfaction and quality of care, it will also present a new challenge and unique opportunity for infectious diseases professionals to become increasingly recognized as critical components of the patient safety movement in the hospital and in the health care community at large.
Potential result
If a hospital does not meet the threshold standards set by VBP, individual doctors will not be held directly accountable, nor receive monetary penalties. An obvious indirect impact of receiving low VBP scores, however, is the reduced financial support for and potential financial strain on hospitals (and consequently the hospitals’ infectious diseases, infection control and antimicrobial stewardship programs).
Currently, each year, approximately 2 million patients acquire HAIs in the United States, costing an estimated $5 billion to hospitals and insurance companies (including CMS). In the next several years, in part due to VBP implementation, Medicare will be paying for fewer of these costs, and hospitals will be absorbing more of these costs.
From an infectious diseases perspective, the hospitals that will benefit the most from VBP will be those that rise to the challenge of reducing and preventing infectious diseases-related conditions, including device-related infections and SSI. It is critical that infectious diseases professionals stay at the forefront of developments related to these new CMS policies and seize opportunities to help direct the focus of hospital management and health care in general toward improvements in infection prevention and patient quality, safety and satisfaction.
References:www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/Hospital-Value-Based-Purchasing.
www.cdc.gov/nhsn.