CMS Issues Final Rule for Value-Based Purchasing Program

The Centers for Medicare & Medicaid Services has issued a final rule for its Hospital Inpatient Value-Based Purchasing program, which allots incentive payments to hospitals based on their performance on certain quality measures, rather than simply reporting data, starting in fiscal year 2013.

Funding for the value-based purchasing program in FY 2013 will come from withholding 1 percent of its payments to hospitals starting Oct. 2012. The pool, estimated to sit at $850 million in the first year, will be distributed as bonuses to hospitals that perform well on various quality measures, including patient experience.

CMS has proposed a weighting scheme — consisting of 70 percent clinical process of care and 30 percent patient experience of care (based on HCAHPS) — for its FY 2013 value-based purchasing program. The selected measures for the first year of the program include 12 quality measures for heart attack, heart failure, pneumonia, surgical care (as measured by the Surgical Care Improvement Project) and healthcare-associated infections. The final measures also include outcomes from the HCAHPS survey.

CMS' final rule also includes final measures for the second year of the value-based purchasing program, which features three 30-day mortality claims-based measures, eight hospital-acquired conditions measures and two composite measures developed by AHRQ. Detailed tables of clinical quality measures for FY 2013 and FY 2014, as well as achievement thresholds, are included in the final rule.

In addition to finalizing scoring methodology, measures and achievement thresholds, the agency has also finalized a policy in which it will exclude scores for any clinical measure for which it reports fewer than 10 cases from a hospital's total performance score. Hospitals that report fewer than 100 HCAHPS surveys during the FY 2013 period will also not be included in that year's performance assessment.

The final rule will go into effect July 1, and the program will begin making incentive payments for discharges occurring on or after Oct. 1, 2012.

Read CMS' final rule on its Value-Based Purchasing Program (pdf).

Related Articles on Value-Based Purchasing:
CMS Proposed 0.55% Pay Cut to Hospitals Includes Withholding Payments for Performance
8 Points on Dealing With Medicare Value-Based Purchasing
The Four Cornerstones of an Exceptional Patient Experience

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