More losers than winners in Medicare's Value-Based Purchasing Program

The Centers for Medicare & Medicaid Services (CMS) has announced its second round of penalties and bonuses to hospitals under the Value-Based Purchasing Program, and the former outnumber the latter.

Medicare reduced payment rates for 1,451 hospitals and increased rates for 1,231 based on 24 quality measures, including patient satisfaction questionnaires. It also incorporated death rates into the assessment for the first time, according to NPR.

The best hospital scores were found in Massachusetts, Wisconsin, New Hampshire, Maine, Nebraska, Utah and Maine, where 60 percent of hospitals saw payment increases, according to Kaiser Health News. Seventeen other states saw reduced reimbursement rates in at least two thirds of hospitals, the article states, including New York, New Mexico, Washington, North Dakota, Nevada and Connecticut.

Although most hospitals that saw increases or reductions last year continued the trend, some were able to improve their scores, the NPR article states. Three hundred hospitals or hospital systems that were previously penalized received a bonus, including Massachusetts General, Nashville's Vanderbilt University Medical Center and Los Angeles' Ronald Reagan UCLA Medical Center. Meanwhile, 416 hospitals that earned bonuses last year received penalities in this latest round, according to the KHN article.

Overall, CMS said in its announcement that slightly more than two-thirds of high-peforming hospitals were high performers last year and about 75 percent of lower-performing hospitals had their incentives adjusted by a factor of less than one. "That's good news too," said Patrick Conway, M.D., chief medical officer at CMS and director of the Centers for Clinical Standards and Quality in his post announcing the lastest scorecard. "The fact that not every higher performing hospital last year made the grade this year, and not every lower performing hospital last year will see payment decline this year, means that hospitals are adjusting to the new world of value-based payment."

Some hospital executives protest that the measures used in the assessment are biased against hospitals that treat the very sickest patients, and give an unfair advantage to physician-owned hospitals that focus on only a handful of specialties, the NPR article states. One such hospital, Little Rock's Arkansas Heart Hospital, which deals exclusively with cardiovascular cases, received an 0.88 percent bonus, the largest awarded.

To learn more:
- here's the CMS announcement
- here's the NPR article
- read the KHN article

 

Suggested Articles

CMS has signed off on Louisiana's plan to use a Netflix-style subscription model to pay for hepatitis C drugs in its Medicaid program. 

The Trump administration is offering $50 million in grants to bolster programs for treatment and recovery from substance abuse.

Arizona’s Medicaid program will cover Lyft's ride-sharing service as a nonemergency medical transport option.