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CMSValueBasedPurchasing+(1).pdf - 28 May 2013 • Nursing...

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28May 2013• Nursing Managementnursingmanagement.comCopyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
www.nursingmanagement.comNursing Management •May 201329Reward or penalty, step up to the plateBy Rosanne Raso, MS, RN, NEA-BC1.8CONTACT HOURSValue-based purchasing:How did your organization fare when the preliminary results of Medicare’sValue-Based Purchasing (VBP) program were posted in late 2012? Effec-tive this year, all hospitals are facing up to a 1% reward or penalty oftheir total Medicare reimbursement based on the results of 20 clinical processand patient experience measures. In hospitals with a large proportion of Medi-care patients and slim profit margins, this 1% may mean the difference betweenbeing in the black and being in the red. The VBP program is projected to growas performance measures expand and the reimbursement risk increases. Haveyou prepared for nursing’s essential contribution to value-based care?Covering the basesVBP began with the Deficit Reduction Act of 2005 as a subset of the Centers forMedicare and Medicaid Services (CMS) Hospital Inpatient Quality Reporting(IQR) program. In the IQR program, hospitals are only required to reporttheirquality measures to receive a 2% incentive, known as “pay for reporting;”achievement levels aren’t evaluated. This program has grown from aninitial 10 quality measures to over 70 measures. The Joint Commis-sion’s required core measures are intentionally aligned withIQR measures so that hospital data collection efforts areconsistent, although some variation still exists.The Deficit Reduction Act also requiredoutcome and efficiency measures to bemade publicly available underthe IQR program. Publiclyreported information isprovided by theCMS on theHospitalWhat’s the score?Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
30May 2013• Nursing Managementwww.nursingmanagement.comValue-Based Purchasing:What’s the score?Compare website (.hospitalcompare.hhs.gov) to helpconsumers assess hospital perfor-mance. The posted information isusually 9 months to more than1 year behind, for example, a mea-surement period ending in Decem-ber 2011 may not have appeareduntil late in 2012. The followingdata categories are currently avail-able online, and VBP results willbe added this year:• patient survey results (HospitalConsumer Assessment of Health-care Providers and Systems[hcahps])• timely and effective care (coremeasures)• readmissions, complications,and deaths• use of medical imaging• Medicare volume and payment.1The original VBP concepts werepublished as “pay for performance.”(SeeVBP in a nutshell.) An intensediscussion ensued, and continues,on the value of tying quality toreimbursement, as well as whichevidence-based measures should beincluded. Needless to say, there’san argument for both sides. WillVBP impact quality or not? Are theevidence-based process measuresaffecting patient outcomes? Is patientexperience a valid indicator forvalue-based care? Does the scoringsystem penalize and reward the righthospitals? Does the VBP programadversely affect safety nethospitalsthat have an increasedpercentage ofdisadvantaged patients? Time willtell as the quest for improved health-carequality in our country continues.

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Nursing, FY, VBP

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