Medicare value-based purchasing program Archives - Safety-Net Association of Pennsylvania

Senate May Tackle Socio-economic Risk Adjustment

With a House bill to adjust Medicare payment penalties based upon the socio-economic challenges posed by the patients some hospitals serve folded into a House bill that passed in June, the Senate may take up this issue during its fall session.
Health economists, policy experts, and providers generally agree that the performance of hospitals that serve especially large numbers of low-income patients is affected in a number of areas, including Medicare readmissions, meeting value-based purchasing criteria, and others.
And while the Centers for Medicare & Medicaid Services acknowledges the challenge, the agency has rejected calls for risk adjustment so far, repeatedly writing that it does not “want to mask potential disparities or minimize incentives to improve the outcomes of disadvantaged populations.”
Meanwhile, a growing body of research has documented that the anticipated impact of serving socioeconomically challenged patients is real and more and more people are joining the call for Congress or CMS to address the problem.
Compounding the challenge is that hospitals that serve such patients are faced with growing financial penalties from Medicare if they fail to perform at levels comparable to hospitals that face fewer challenges.
For a closer look at the issue, the arguments on both sides, and the prospects for congressional action this fall, see this article from CQ Roll Call presented by the Commonwealth Fund.

PA Safety Net Admin2016-09-20T06:00:19+00:00September 20th, 2016|Medicare|Comments Off

Is Medicare “Pay for Performance” Doing the Job?

Three Medicare initiatives – its hospital readmissions reduction program, value-based purchasing program, and hospital-acquired condition program – were designed to improve the quality of care provided to beneficiaries while eventually reducing the cost of that care.
But are they living up to their billing? That is the question considered in the Health Affairs article “Assessing Medicare’s Hospital Pay-For-Performance Programs and Whether They Are Achieving Their Goals.” Find the article here.

PA Safety Net Admin2015-08-10T06:00:27+00:00August 10th, 2015|Medicare|Comments Off

Patient Satisfaction Survey Results Misleading?

A new report from a non-partisan bioethics institute suggests that the patient satisfaction surveys that Medicare uses as part of its value-based purchasing program may not be providing the kind of information on which Medicare payments should be based.
According to the Hastings Center report “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?” the surveys appear to blend patient satisfaction with their experience while hospitalized with the quality of care they received during that hospitalization and that “Good ratings depend more on manipulable patient perceptions than on good medicine.”
Currently, patient satisfaction is a major component of Medicare’s value-based purchasing program and hospitals can be rewarded or penalized based on their patients’ satisfaction as measured in surveys. The report notes that “The current institutional focus on patient satisfaction and on surveys designed to assess this could eventually compromise the quality of health care while simultaneously raising its cost.”
Find the complete study here, on the web site of the Hastings Institute.

PA Safety Net Admin2015-06-12T06:00:16+00:00June 12th, 2015|Medicare|Comments Off

Medicare Giveth and Medicare Taketh Away

With a growing number of Medicare programs basing portions of future reimbursement on meeting specific performance metrics, hospitals are finding that they need a scorecard to keep track of their successes and failures.
Medicare’s value-based purchasing program, for example, is rewarding 1700 hospitals this year for their performance under the program. Another 1360 hospitals are being penalized under the program.
But among those 1700 winners, fewer than 800 will see their bonuses because their losses under Medicare’s hospital readmissions reduction program and health care-associated infection program exceed their value-based purchasing winnings.
Overall, the average bonus for large hospitals for the three programs combined is nearly $213,000 while the average penalty for such hospitals is approximately $1.2 million. For hospitals with 200 or fewer beds, the average bonus is about $32,000 and the average penalty approximately $131,000.
Pennsylvania’s hospitals were divided evenly among winners and losers: of 147 hospitals assessed as part of these programs, half received bonuses and half were penalized.
Not included in the totals are the six percent of hospitals that face new penalties for failing to make enough progress in their transition to electronic health records.
For a closer look at how hospitals are faring under Medicare’s various performance-based program, as well as how hospitals in other states fared, see this Kaiser Health News story.

PA Safety Net Admin2015-01-29T06:00:37+00:00January 29th, 2015|Uncategorized|Comments Off

Readmissions and Quality: Are They Related?

A new study casts doubt on a major principle underlying a good deal of recent federal health care policy.
That principle holds that hospitals that have lower rates of 30-day readmissions of Medicare patients provide better, more economical care than those with higher readmission rates.
But that may not be true.
According to an examination of the performance of safety-net hospitals in California published in the journal Health Affairs, those safety-net hospitals are more likely than others to be penalized by Medicare’s hospital readmissions reduction and value-based purchasing programs.
At the same time, however, these same hospitals had lower 30-day, risk-adjusted mortality rates for patients treated for myocardial infarction, heart failure, and pneumonia. The safety-net hospitals also had marginally lower adjusted Medicare costs.
Find out more about the findings of the study “California Safety-Net Hospitals Likely to be Penalized by ACA Value, Readmission, and Meaningful-Use Programs,” which can be found here, on the web site of the journal Health Affairs.

PA Safety Net Admin2014-08-21T06:00:31+00:00August 21st, 2014|Affordable Care Act, Health care reform|Comments Off

Group to Assess Impact of Socioeconomic Factors on Care

The National Quality Forum (NQF) will perform a “robust trial” to assess the role and impact of sociodemographic factors on health care outcomes.
In a news release, the NQF announced that

Sociodemographic factors can be socioeconomic, e.g., income, education, and occupation, and demographic, e.g., race, ethnicity, and primary language. Growing evidence shows that sociodemographic factors may influence patient outcomes, which has implications for comparative performance measurement used in pay-for-performance programs.

Among the socioeconomic and sociodemographic factors the NQF will consider are income, education, and occupation, and demographic considerations such as race, ethnicity, and primary language.
With the Affordable Care Act requiring Medicare to adjust payments based on outcomes such as hospital readmissions, value-based purchasing requirements, hospital-acquired conditions, and more, reviews of the preliminary results of such programs have led some to question whether hospitals that serve especially large numbers of low-income patients – like Pennsylvania’s safety-net hospitals – may be especially and unfairly harmed by such programs.
Learn more about the NQF plan for a new study from this news release and find a link to further information about the planned study as well.

PA Safety Net Admin2014-07-25T06:00:35+00:00July 25th, 2014|Affordable Care Act|Comments Off

Report Questions Fairness of Medicare Quality and Incentive Programs

A draft technical report by the National Quality Forum has called into question the fairness of Affordable Care Act Medicare programs that seek to provide financial incentives to hospitals that meet selected quality care standards and penalize those that fail to meet those standards.
According to the report, which was commissioned by the Obama administration, these programs unfairly penalize hospitals that care for especially large numbers of low-income seniors – hospitals like those that belong to the Safety-Net Association of Pennsylvania.
The report notes, according to the New York Times, that

Low-income people may be unable to afford needed medications or transportation to doctor’s offices and clinics, the panel said. If they have low levels of formal education or literacy, they may have difficulty understanding or following written instructions for home care and the use of medications. In addition, the clinics and hospitals they use may lack the resources and high tech equipment needed to diagnose and treat illnesses.

Among the programs cited for this problem are Medicare’s value-based purchasing program and its hospital readmissions reduction program.
Read more about the programs’ challenges, as well as the views of those who believe the programs are working as intended and should not be adjusted, in this New York Times article. Go here, to the National Quality Forum’s web site, for a direct link to the study, titled “Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors.”

PA Safety Net Admin2014-04-28T10:41:20+00:00April 28th, 2014|Affordable Care Act, Safety-Net Association of Pennsylvania|Comments Off

Safety-Net Hospitals Bear Brunt of Medicare Penalties

Hospitals that serve the largest proportion of low-income patients are suffering the greatest financial penalties under Medicare’s value-based purchasing program.
Collectively, hospitals that serve the most low-income patients are seeing their Medicare payments reduced 0.09 percent during year two of the Medicare program while hospitals that serve the fewest low-income patients have seen their Medicare payments rise 0.06 percent, according to a new study by a Harvard School of Public Health professor.
Medicare’s value-based purchasing program, mandated by the Affordable Care Act, bases penalties and bonuses on 24 quality measures.
In Pennsylvania, 45 percent of the state’s hospitals received bonuses while 53 percent were penalized; both figures are the same as the national averages. The average bonus for Pennsylvania hospitals was 0.24 percent – the national average – while the average penalty was 0.20 percent, slightly lower than the national average of 0.26 percent.
The author of the study suspects that the performance of safety-net hospitals may be suffering from the manner in which their patients are responding to the patient satisfaction survey that is one of the determining factors in evaluating hospital performance.
For a closer look at the study and its findings, see this Kaiser Health News report.

PA Safety Net Admin2013-11-22T06:00:26+00:00November 22nd, 2013|Affordable Care Act, Health care reform|Comments Off

Medicare Reveals First Results of Quality Program

Slightly more than half of all U.S. hospitals will receive enhanced payments from Medicare and slightly fewer than half will see their payments reduced slightly as a result of the first reporting period for Medicare’s new value-based purchasing program.
The largest bonus will be awarded to Treasure Valley Hospital, in Utah. Each of its Medicare payments will rise 0.83 percent. The largest penalty will be assessed to Auburn Community Hospital, in Syracuse, which will see its Medicare payments reduced 0.9 percent. Two-thirds of all hospitals will see their payments rise or fall less than 0.25 percent.
Medicare’s value-based purchasing program, created by the Affordable Care Act, seeks to enhance provider accountability for the care they deliver. Seventy percent of a hospital’s score is based on its performance according to 12 basic standards of care and the rest of the score is based on the results of patient satisfaction surveys.
The program will be expanded in the coming years to encompass more standards of care. A companion program, based on Medicare readmissions within 30 days of patient discharge, is already under way and rewarding top performance and penalizing underperforming hospitals.
According to the figures released, 51 percent of Pennsylvania hospitals will receive bonuses through the value-based purchasing program and 49 percent will be penalized. Between the two programs – the value-based purchasing program and the readmissions reduction program – 20 percent of Pennsylvania hospitals will see a net increase in payments and the remaining 80 percent either broke even or will see their payments reduced.
Read more about the quality program in this Kaiser Health News report , which also offers links to lists of the results for every hospital in the country for both the Medicare value-based purchasing and readmissions reduction programs.

PA Safety Net Admin2012-12-31T06:00:30+00:00December 31st, 2012|Uncategorized|Comments Off

New Medicare Wrinkle May Hurt Safety-Net Hospitals

A new Medicare program that bases payments to hospitals in part on patient satisfaction with those hospitals could be especially harmful to the nation’s safety-net hospitals.
The Medicare value-based purchasing program, which took effect on October 1, will withhold one percent of all hospitals’ Medicare payments and then redistribute that money based on hospitals’ compliance with selected standards-of-care requirements and on the results of surveys of hospitalized Medicare patients. The withheld one percent will then be redistributed to hospitals that perform well based on these criteria. Beginning in 2017, two percent of hospitals’ Medicare payments will be withheld and eventually redistributed in this manner.
Learn more about the Medicare value-based purchasing program and how hospitals are preparing for the survey component of its payment adjustments in this Wall Street Journal article .

PA Safety Net Admin2012-10-16T06:00:55+00:00October 16th, 2012|Health care reform|Comments Off

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