The Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (VBP) Program has increased focus on infection prevention over the last several years by tying a rising percentage of payments to outcome measures that include infection rates.
The program adjusts payments made by CMS to hospitals based on the quality of care provided to patients. In 2016, Medicare reduced payments to hospitals by 1.75% of their base operating Medicare severity diagnosis-related group (MS-DRG) payments to fund the program. In 2017, that percentage will rise to 2%.1
Forty percent of the CMS Total Performance Score (TPS) used to evaluate individual hospital performance was derived from the outcome domain in 2016, making it the most significant factor in hospital payments under the value-based payment program. The 2016 outcome domain added infection measures for catheter-associated urinary tract infections and surgical site infections associated with colon surgery and abdominal hysterectomy to the existing central line-associated bloodstream infections measure and three hospital mortality measures (acute myocardial infarction, heart failure and pneumonia).2
For fiscal 2017, CMS created a new safety domain that accounts for 20% of the Total Performance Score this year and will rise to 25% in 2018. The new domain primarily measures infection rates, making them more important than ever. CAUTI and CLABSI as well as colon and hysterectomy-associated surgical site infections were moved over from the outcomes domain. In addition, the safety domain now includes two new measures that increase the importance of infection prevention: hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium difficile infections. The other measures in this domain are the composite complication/patient safety for selected indicators and elective delivery prior to 39 weeks.3
Of the three pay-for-performance programs implemented by CMS, only the value-based payment program offers the opportunity for high performers to receive incentives and increase revenues. The restructuring of the domains will continue to diminish hospital focus on process of care measures, which decline in importance from 25% to 5% in the FY 2017 schema and disappear in 2018. Hospitals must now focus on higher level outcomes and those that emphasize infection prevention and perform well in the new safety domain especially as its share of the total quality measure rises next year.
The upside for performing well can be quite significant. The highest performing hospitals can receive a bonus payment of up to 1.75% of their annual DRG payments from CMS. In 2017, providing high quality or care clearly pays.
- Fiscal Year (FY) 2016 Results for the CMS Hospital Value-Based Purchasing Program. New Release. October 26, 2015.
- Hospital Value-Based Purchasing. CMS.gov. October 30, 2015.
- Fontana E. Adjustments ahead: Your value-based purchasing forecast. The Advisory Board Company. July 27, 2015.