The Medicare Payment Advisory Commission (MedPAC) overwhelmingly supports a proposal to redesign quality and value programs for hospitals, even if the details still need to be ironed out.
The proposal would merge the Hospital Readmissions Reduction Program and the Hospital Value-Based Purchasing Program into the Hospital Value Incentive Program (HVIP).
HVIP was designed to be budget-neutral, but the withheld amount could gradually increase from 2% to 5%, representing a 250% to payment adjustments.
During a Friday meeting, commissioners expressed considerable enthusiasm for this component of the proposal. Some even said the withheld percentage should go directly to 5% rather than increase gradually.
The new program would evaluate quality based on readmissions, mortality, spending and patient experience; policymakers could either weigh these domains equally or favor some more than others.
Much of the commission’s discussion involved these measures. While some felt each should be weighted equally for simplicity’s sake, several others believed the two clinical measures deserved more weight.
“I believe … we should give more emphasis to clinical outcomes measures,” said commissioner Paul Ginsburg, Ph.D., of the Brookings Institution. However, he continued, “I don’t think we should downgrade spending; to pretend we only care about quality is absurd.”
Ginsburg and other commissioners discredited the patient experience metric, which would be based on the federal Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
Although patient experience is “not unimportant,” HCAHPS lacks “statistical validity,” said commissioner Pat Wang, J.D.
Toward the end of the meeting, however, commissioner Marjorie Ginsburg made a solid case in favor of the patient experience measure, pointing to a study she co-authored that solicited the public’s views on quality measures.
“People talked about [the patient experience] with great passion and significance,” Ginsburg said.
HVIP would also tier hospitals by the percentage of dual-eligible beneficiaries they serve, a system called “peer grouping,” to account for socioeconomic risk factors. Initial models suggested hospitals that serve the highest proportion of poor patients would be more likely to receive rewards under this system than the current one. This provision was popular among all commissioners.
Finally, the new system would eliminate the Inpatient Quality Reporting Program and the Hospital-Acquired Condition Reduction Program.
Some commissioners, including Wang, Kathy Buto, and Karen DeSalvo, M.D., thought it would still be worthwhile to measure hospital-acquired infections (HAIs) in some capacity. Every year, the U.S. sees 2.1 million HAIs that cost Medicare $24 billion.
Overall, however, the commission sang what Buto called a “chorus of compliments” for the proposal.