Value-Based Purchasing, Readmissions Reduction Programs Effective Today

CMS' value-based purchasing and readmissions reduction programs went into effect today.

Both federal reporting programs, which are required under healthcare reform, are designed to incentivize hospital performance across a range of quality metrics. Under both programs, hospitals also face monetary penalties if they fail to meet specified performance measures.

Value-based purchasing
Under the VBP Program, Medicare will make incentive payments to hospitals beginning in FY 2013 based on either how well they perform on each measure or how much they improve their performance on each measure compared to their performance during a baseline. Hospitals will earn scores for their performance on measures and dimensions in quality and patient experience during the performance period of July 1, 2011, to March 31, 2012.

The FY 2013 baseline performance period is July 1, 2009 to March 31, 2010. The measure types include outcome processes, patient experience and cost/resource use.

Readmissions reduction
This program requires CMS to reduce payments to hospitals participating in the Inpatient Prospective Payment System that report excessive readmissions, effective for discharges beginning yesterday. In the FY 2012 IPPS final rule, CMS finalized the readmission measures for acute myocardial infarction, heart failure and pneumonia and the calculation of the excess readmission ratio, which will then be used, in part, to calculate the readmission payment adjustment under the Hospital Readmissions Reduction Program. CMS established a policy of using three years of discharge data and a minimum of 25 cases to calculate a hospital's excess readmission ratio of each applicable condition.

For FY 2013, the excess readmission ratio will be based on a discharges occurring during the three-year period of July 1, 2008 to June 30, 2011. CMS plans to continue implementation of this program in its FY 2013 IPPS rulemaking cycle.

More Articles on Quality Reporting:

3 Tips for Publicly Reporting Quality Data From Aligning Forces for Quality

6 Highlights From CMS' Final Stage 2 Meaningful Use Rule

CMS Throws Out Outpatient Quality Reporting Measure

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