Value-based purchasing scores remain volatile

Data from Medicare's value-based purchasing program contain broad variations and few clear patterns, according to a new report from Leavitt Partners, and the report's author says it may take solutions such as a separate program for low-volume hospitals or combining Medicare's care-quality programs to achieve meaningful improvements.

With four years of purchasing scores available for analysis, the changes the program is driving are finally beginning to take shape, according to the report, but the data also reveal that, rather than typical up or down trends, numerous scores "bounced up and down over time," David Muhlestein, Leavitt Partners' senior director of research and development and the author of the report, told FierceHealthcare in an exclusive interview.

"You might have little, teeny-tiny changes in your score year over year that might just be random variations but due to all of the other random variation happening across the system, across the country, that might actually translate into a really big difference in your performance on this," he says. Individual hospitals, the report found, had results ranging from an expected $8 million loss to a $6 million gain.

Much of this variation, Muhlestein speculates, is to do with the presence of data from low-volume hospitals. "When you have [only] 25 patients affecting your score there's a lot of random variation that can occur," he says. Siloing of data also remains a problem, Muhlestein says; if the federal government were to merge its value-based purchasing, hospital-acquired condition reduction and readmission reduction programs, a more accurate picture of hospital care quality would emerge from the resulting data.

Despite the volatility, he adds, the data only represent a small proportion of hospital revenues, meaning it remains to be seen whether the variations will provide incentives to hospitals. In future research, he says, the Centers for Medicare & Medicaid Services should explore whether the value-based purchasing program is "big enough to encourage a change in behavior."

The data also show broad differences state by state, Muhlestein told FierceHealthcare. State population characteristics could account for some of this variation, he says, but so too could the challenge of reporting purchasing data in the first place and possible differences in how different states and regions report.

Overall, hospitals in the northern states and the Eastern seaboard performed better, he adds, which may tie into overall lower poverty levels and higher rates of insurance coverage. This backs up research from the Government Accountability Office published in October that shows financially strong hospitals have benefited most from the program since it began, FierceHealthcare previously reported, echoing common complaints that CMS' care-quality improvement programs penalize hospitals for factors beyond their control.

To learn more:
- download the report