We hear a lot in the news about “changes in healthcare,” but other than expecting fewer services for greater costs, do we really know what that means? It ends up it means many things do different people. Depending on your age and your socioeconomic standing there can be very different meanings. We want to explore one difference – what is called “Value Based Purchasing” (VBP) or referred to as “Pay for Performance.”

We are all interested in value and performance, but what does this really mean? Although, the government has made this incredibly complicated, we will offer you the basics. Value Based Purchasing refers to Medicare’s new approach to handling payment to providers, and at this time just hospitals. The Centers for Medicare and Medicaid Services (CMS) has developed a new way to evaluate how much hospitals will be reimbursed.

The CMS website explains the program as follows: “The Hospital Value Based Purchasing Program (Hospital VBP) is designed to link payment to quality processes and outcomes and to transform CMS from a passive payer of claims to an active purchaser of care.” In order to accomplish this goal, the CMS has established a set of criteria for hospitals to meet or exceed in order to receive their reimbursement. The criteria are broken into two parts: clinical outcomes and patient perception. The evaluation of these criteria is based seventy percent (70%) on clinical outcomes and thirty percent  (30%)on patient perception.

Clinical outcomes are measures such as; Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time, Heart Failure Discharge instructions, Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival, Blood Cultures Performed in the ED Prior to Initial Antibiotic Received in Hospital…etc – there are 12 in total that will be considered by CMS. Hospitals are required to report their performance on these measures annually.

The thirty percent based on “patient perception” will be evaluated by national surveys sent to patients – “Hospital Consumer Assessment of Healthcare Providers &Systems Survey” – or HCAHPS surveys. These surveys allow the patient to rate their care in the areas of:

·        Communication with Nurses

·        Communication with Doctors

·        Responsiveness of Hospital Staff

·        Pain Management

·        Communication About Medicines

·        Cleanliness and Quietness of Hospital Environment

·        Discharge Information

·        Overall Rating of Hospital

Think about your last hospital stay and how you would have rated the items above. We will provide more detail on what this means in the next blog! Any questions so far?