The Hospital Value-Based Purchasing (VBP) Program is part of the Centers for Medicare & Medicaid Services (CMS) effort to link Medicare’s payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting.1 Hospitals are paid for inpatient acute care services based on the quality of care not just the volume of services provided.
Congress authorized the Hospital VBP as part of the Affordable Care Act. This program uses the hospital quality data reporting infrastructure developed for the Hospital Inpatient Quality Reporting (IQR) Program. Under the VBP, incentive payments are made to hospitals based on either:2
How well they perform on each measure, and
How much they improve their performance on each measure compared to their performance during a baseline period.
How is the HVBP Analyzed by CMS?
CMS determines whether a hospital will suffer payment reductions based on the hospital’s measure results and scoring. There are three major steps taken to determine a hospital’s Total Healthcare-Associated Condition (HAC) Score.3
Hospitals are classified based on their measure results, where each hospital is assigned a measure score between 1 and 10 for each measure.
Measure scores are used to determine the domain scores.
Domain 1 score, for FY 2016, is determined by points assigned for the Patient Safety Indicator (PSI) 90 composite index value - the only measure in Domain 1.
Domain 2 score is composed of CLABSI, CAUTI, and SSI. The Centers for Disease Control and Prevention (CDC) calculated standardized infection ratios (SIRs) for those three measures using chart-abstracted surveillance data reported to NHSN (National Healthcare Safety Network) for infections occurring from January 1, 2013 through December 31, 2014 for the FY 2016 HAC Reduction Program Calculations. Measure scores are then used to determine domain scores.
A hospital’s Total HAC score is determined by the sum of the weighted Domain1 (25%) and Domain 2 (75%) scores. If a hospital only has a score for one of the domains, then a weight of 100 percent will be applied to the domain for which the hospital has a score.
How does VBP impact infection prevention?
How well does your infection prevention team quickly and proactively use surveillance to identify risks that could cause a patient to acquire a hospital-associated infection (HAI)? Does the C-Suite understand the positive impact infection preventionists can provide to the HVBP? Can you analyze your HAI rates and offer advice on how to prevent infections and reduce the patient’s length of stay? The FY 2016 measures are listed above. In Fiscal Year 2017, CMS include will add:
- Hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
- Clostridium difficile infection
Many infection preventionists (IPs) are more comfortable with assessing clinical situations and providing education rather than understanding value-based purchasing, reimbursements, and the bottom line. The IP should understand VBP and articulate its basic tenets in order to demonstrate the value of the infection prevention program to the hospital’s value-based purchasing program.
Centers for Medicare and Medicaid Services. Hospital Based Purchasing. Accessed on December 28, 2015: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing/index.html
Centers for Medicare & Medicaid Services. Medicare Learning Network. Accessed on December 28, 2015: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf
CMS.gov. Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program. Accessed February 11, 2016. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-12-10-2.html