Hospital value-based purchasing not linked to improved clinical process measures, study finds

The Medicare Hospital Value-Based Purchasing Program, established under the ACA, was not associated with clinical process or patient experience improvements but was associated with a decrease in mortality in pneumonia patients, according to a study published in The New England Journal of Medicine.

The HVBP model rolled out quality performance–based adjustments of up to 1 percent to Medicare reimbursements for acute care hospitals in 2013. In a study funded by the National Institute on Aging, Andrew Ryan, PhD, associate professor of health management and policy at the University of Michigan School of Public Health in Ann Arbor, and researchers analyzed if acute care hospitals exposed to HVBP saw quality measures improve when compared to those not exposed to the model. The study evaluated the first four years of the program.

Researchers compared composite measures of clinical process and patient experience and 30-day risk-standardized mortality rates among heart attack, heart failure or pneumonia patients at HVBP-exposed and nonHVBP-exposed hospitals. The number of HVBP-exposed hospitals in the study ranged from 1,364 to 2,615 depending on the quality measure, and the number of control hospitals ranged from 31 to 617 depending on the quality measure.

The study found improvement in clinical process and patient experience measures were not significantly greater for hospitals exposed to HVBP than those unexposed to the model. Researchers found HVBP also was not associated with significant decreases in mortality in heart attack patients and heart failure patients. However, the study uncovered a significant decrease in mortality in pneumonia patients in hospitals exposed to HVBP compared to those not exposed to the program.

Researchers concluded "HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures." 

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