In November 2007, the Centers for Medicare & Medicaid Services (CMS) issued a report to Congress proposing a Medicare hospital value-based purchasing (VBP) program. In its proposal, which would require congressional approval, CMS would convert the current hospital inpatient pay for quality reporting system to a pay for performance model, which it refers to as VBP. In the CMS proposal, hospitals would fund a VBP performance pool by withholding some portion of the diagnosis related group (DRG) payment.
In November 2007, the Centers for Medicare & Medicaid Services (CMS) issued a report to Congress proposing a Medicare hospital value-based purchasing (VBP) program. In its proposal, which would require congressional approval, CMS would convert the current hospital inpatient pay for quality reporting system to a pay for performance model, which it refers to as VBP. In the CMS proposal, hospitals would fund a VBP performance pool by withholding some portion of the diagnosis related group (DRG) payment. Hospitals’ performance versus established inpatient quality measure would then be measured against that of their peers, and based on their performance relative to that of their peers, they would be able to earn back their full DRG amount. CMS’ proposed VBP structure would, through its design structure, leave unspent funds in the performance pool; CMS does not indicate whether these funds would be returned to hospitals in the form of additional payments to high performing hospitals or some other mechanism, or whether they would be withheld as savings to the Medicare program.
In order to implement VBP, CMS would require Congressional authorization. However, CMS’ VBP plan is consistent with recommendations made by the Medicare Payment Advisory Commission (MedPAC), an influential advisory board to Congress, and has attracted considerable congressional attention, from influential members of both parties.
The Centers for Medicare & Medicaid Services (CMS) has announced that the calendar year (CY) 2013 Medicare Spending Per Beneficiary (MSPB) measure results have been recalculated. After identifying an issue affecting standardized payment data used in calculating the MSPB measure results for outpatient service claims rendered in 2013, CMS has released revised MSPB hospital-specific reports (HSRs) and will include the updated MSPB measure results in the downloadable Hospital Compare archive files after hospitals have had 30 days to preview their confidential reports.
CMS is providing HSRs for the MSPB measure review and corrections period that begins Oct. 29 and ends Nov. 30. This process does not allow hospitals to submit additional corrections related to the underlying claims data used to calculate the rates, nor add new claims to the data extract used to calculate the rates.
CMS will not make any payment adjustments for the FY 2015 Hospital Value-Based Purchasing program. For further assistance, contact the Hospital Inpatient Value, Incentives, and Quality Reporting Outreach and Education Support Contractor through the Inpatient Questions and Answers tool at https://cms-ip.custhelp.com.
The Government Accountability Office (GAO) has released a report evaluating the Hospital Value-Based Purchasing (HVBP) program, including its effect on Medicare payments to hospitals, quality of care provided by hospitals and the selected hospitals’ quality improvement efforts. GAO found that, among the estimated 3,000 hospitals eligible for the HVBP program, bonuses and penalties related to the program amounted to less than 0.5 percent of applicable Medicare payments each year. The report also found no significant change in hospitals’ performance on the quality measures, but it notes that trends in performance may emerge as the program evolves.
The Centers for Medicare & Medicaid Services (CMS) reminds hospitals that all review and corrections calculation requests for the fiscal year (FY) 2016 hospital value-based purchasing (VBP) percentage payment summary reports (PPSRs) must be submitted no later than Aug. 31 at 11:59 p.m. (PT). Hospitals that do not submit a formal review and correction calculation request by Aug. 31 will waive eligibility to appeal the recalculation of their performance scores. Hospitals may request an appeal only after first requesting a formal review and correction of their performance scores, and they must have also received a decision from CMS denying their request.
The Centers for Medicare & Medicaid Services will host a webinar April 21 at 11 a.m. (PT) about the hospital value-based purchasing program’s PSI-90 composite and 30-day mortality measures. The webinar will provide an overview of the hospital-specific reports (HSR) for the measures, guiding attendees through each section and explaining how to complete and submit a review and correction request. Presentation slides will be available online the day before the webinar at www.qualityreportingcenter.com/events. To register, visit https://cc.readytalk.com/r/e07eg98z1nip&eom.