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Enable Value Based Purchasing to improve performance and save lives

Enable Value Based Purchasing


Improve Performance and Save More Lives

Improve performance with value based purchasing

Helping hospitals predict at risk patients and manage HVBP performance through 30-day mortality predictions, SCIP metrics and CLABSI predictions

The Hospital Value-Based Purchasing (VBP) program was created by the Centers for Medicare & Medicaid Services (CMS) to incentivize acute-care hospitals to improve the quality of care delivered for Medicare patients. Participating hospitals are rewarded based on how closely they follow clinical best practices and how well they enhance the patient experience of care.

Under-performing hospitals are penalized under the program through a percentage reduction in base operating DRG payments. The money that is collected is used to fund incentive payments for those hospitals who are performing at or above target levels.

Performance is based on the hospital’s achievement and improvement scores across each VBP measure. The total performance score for a hospital reflects how well they performed compared to all hospitals and how much they improved their own performance. (For more information on the VBP program, please visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing.html)

Jvion's solution uses Clinical Patient Pod technology and advanced artificial intelligence to help hospitals predict at risk patients and manage performance related to the VBP program including:

  • 30-day mortality predictions for:
    • Acute myocardial infarction
    • Heart failure
    • Pneumonia
  • Surgical Care Improvement Project (SCIP) metrics
  • Central line-associated blood stream infection (CLABSI) predictions

These insights are helping hospitals:

  • Reduce CLASBI by 10%
  • Reduce 30-day mortality for all target diseases/illnesses by 5%
  • Improve TPS by 10%
  • Improve SCIP measures
  • Prepare for FY2016 metrics

Value Based Purchasing (VBP) Program – Topic Deep Dive

The Centers for Medicare & Medicaid Services (CMS) introduced the Hospital VBP Program final rule in 2011. The program is aimed at penalizing hospitals for “deficiencies that pose immediate jeopardy to the health or safety of patients”.

Under the Hospital VBP, CMS rewards hospitals base on:

  • Quality of care
  • How closely they follow clinical best practices
  • How well they enhance the patient experience

This program is a key component in the drive to reward hospitals based on the quality of outcomes rather than the quantity of services provided.

To measure a hospital's performance, CMS looks at a set of dimensions and measures that are grouped into quality domains. Each FY, the domains change slightly. For FY 2016, the applicable domains include:

  • Patient and Caregiver-Centered Experience of Care/Care Coordination
  • Safety
  • Clinical Care: Outcomes and Process
  • Efficiency and Cost Reduction

(For a full list of the measures included by FY, please visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf)

To tabulate a hospital’s Total Performance Score (TPS), CMS evaluates its achievement and improvement scores. Achievement scores are based on a comparison of a hospital’s rates during a given performance period against all other hospitals included in the program. Improvement points are based on a hospital’s performance against its own baseline rates. Consistency points are awarded based on a hospital’s performance on the Patient Experience of Care dimension against all hospitals Patient Experience of Care rates for a given period. All of these scores are normalized and weighted to reach a final TPS.

The following steps (provided within the Hospital Value-Based Purchasing Factsheet*) outline the process:

  • Step 1: Calculate achievement and improvement scores for each measure or dimension
  • Step 2: Add the greater of either the achievement or improvement scores for each measure or dimension
  • Step 3: Normalize the domain score
  • Step 4: Calculate the consistency score
  • Step 5: Add the consistency score to the normalized score from step 3
  • Step 6: Multiply the domain score by the specified weight (determined by FY)
  • Step 7: Add together the weighted domain scores

Recognizing that the program has expanded to include additional domains and that not all hospitals have the data for every dimension or measure, CMS will calculate a TPS score for facilities with a portion of the domain scores. For FY 2017, hospitals will data in at least three of the four domain scores can receive a TPS.

Program performance and baseline periods used in the calculation vary by domain and FY. Generally speaking, performance periods look at data from the prior two years. For example, performance data used to determine the FY 2017 Efficiency and Cost Reduction domain score are from Jan 1, 2015 – Dec 31, 2015.

For more information on the Hospital VBP program, visit the program overview page on the CMS website: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html?redirect=/hospital-value-based-purchasing/.

Find out how Jvion's solution can help manage your performance related to the Hospital Inpatient VBP Program. Contact us at demo@jvion.com.

References:

- Hospital Value-Based Purchasing Factsheet. Department of Health and Human Services, Centers for Medicare & Medicaid Services. ICN 907664 September 2015; https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf