Michael Brady October 29, 2019
More than 1,500 participating
hospitals will receive about $1.9 billion in bonuses for the fiscal year 2020
under the CMS' Hospital Value-based Purchasing Program, the agency revealed on
Tuesday.
The results are about the same as
last year, with about 55% of participants scoring bonuses. The program, which
started in 2012, increases or decreases payments to hospitals under the
Inpatient Prospective Payment System depending on the quality of care they
deliver to patients.
Inpatient hospital care accounts
for the largest share of Medicare spending.
The value-based pay program is part
of the agency's broader efforts to cut healthcare expenditures and improve
quality by moving away from traditional fee-for-service payments. Those
payments contribute to overuse and unmanageable costs throughout the healthcare
system because they pay for the volume of services provided instead of patient
outcomes.
But the program might not be living
up to its expectations.
The program hasn't had much of an
impact on quality, according to a report from the U.S. Government Accountability
Office. It's also unclear whether the program's small financial rewards are
likely to impact how hospitals deliver care to their patients.
GAO found that the "program
generally reinforced ongoing quality improvement efforts, but did not lead to
major changes in focus."
The program reduces inpatient
payments to about 2,700 hospitals by 2% so that Medicare can pay out bonuses to
hospitals that score well in four areas: clinical care, safety, person and
community engagement, and efficiency and cost reduction. The CMS weighs each
area equally.
The highest-performing hospitals
can earn bonuses greater than the 2% payment reduction, while others may see no
payment increase at all. The program is budget neutral, so it doesn't increase
overall healthcare spending.
Just under 60% of the hospitals
will see small changes in their payments, less than half a percent up or down.
The average net payment adjustment is 0.16%. The best-performing hospital in
2020 will get a pay bump of 2.93%, while the worst-performing hospital will
have its payments slashed by 1.72%, according to the CMS.
The average total performance score
increased from 38.1 in the fiscal year 2019 to 38.5 in the fiscal year 2020.
Small and rural hospitals performed better than the national average, with an
average total performance score of 42.8.
Urban hospitals outperformed rural
hospitals on clinical outcomes but trailed in all other measures, including
safety, person and community engagement, and efficiency and cost reduction.
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