To help hospitals anticipate and understand their scores (as well as the corresponding incentives or disincentives) during the first two years of the program, Qualis Health developed our Model VBP Worksheets and freely distributed them for any interested hospital to use.
Please note that these models do not take into account changes to the VBP program following FY2014.
May 2014. Get an overview of changes for hospitals and skilled nursing facilities.
Under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) updated Medicare payment policies and rates for inpatient hospital stays. Medicare's hospital value-based purchasing (VBP) program ties payment to hospitals' performance on a number of quality measures.
Precise calculations change year to year; it is important that hospitals stay current on what measures are included and how their performance on those measures during defined performance periods will roll up into an overall total performance score (TPS). CMS publishes these details each year through final rule making, typically released in August. (Final rules and other announcements are regularly posted to CMS' VBP overview page.)
CMS published the final rule for FY 2017 on August 22, 2016 and can be downloaded from the Federal Register, and it provides updates to payment policies and penalty programs through FY 2022. See highlights of changes made to the Hospital VBP program for acute care PPS hospitals as well as the HAC penalty and Readmissions Reduction Program for FY 2019. Because scores for FY 2019 penalties will largely be based on 2017 performance, we have provided a FY2019 Hospital VBP Overview with achievement threshold and benchmark targets for 2015 performance. Facilities are encouraged to “get ahead of the curve” by prioritizing improvement efforts to these measures. (View the FY 2018 Overview and the FY 2017 Overview for reference.)
Qualis Health's model worksheets (see sidebar) were helpful during the first two years of the program because hospitals could independently compute and input data for most measures in an almost real-time fashion. This helped hospitals monitor performance as well as forecast their potential TPS. However, with the increasing inclusion of complex risk-adjusted measures into the program, many hospitals must now rely on estimates of their performance on specific measures during specific time frames, making data entry and output from estimation tools, like model worksheets, less precise.
To be successful within the VBP program in the coming years, hospitals will need to maintain highly reliable performance on process measures while shifting their efforts to optimize their performance on measures of patient outcomes, patient experience of care, and spending per beneficiary as the weight given to these domains when computing the TPS will be increasing while the weight given process measures will be declining.