On October 1, 2012, the Centers for Medicare and Medicaid Services (“CMS”) began withholding 1% of hospital Medicare reimbursement payments as a part of the Value-Based Purchasing (“VBP”) program. The withheld amount will increase 0.25% each fiscal year until it is capped at 2% for FY 2017. Under the VBP program, hospitals compete with one another based on quality and patient satisfaction performance measures for a share of the withheld money.
In FY 2015, the VBP program will determine each hospital’s Total Performance Score (“TPS”) based on its performance in four domains. The domains used to calculate the TPS are: Clinical Process of Care (20%); Patient Experience of Care (30%); Outcomes (30%); and Efficiency (20%). The performance periods for FY 2015 have either already begun or will begin soon:
- Clinical Process of Care: 1/1/2013 – 12/31/2013
- Patient Experience of Care: 1/1/2013 – 12/31/2013
- Outcomes: 10/1/2012 – 6/30/2013
- Efficiency: 5/1/2013 – 12/31/2013
Hospitals’ performance information pertaining to measure rates, condition-specific scores, domain-specific scores and TPS will be posted on the Hospital Compare Website. CMS anticipates posting this information on the website in April 2013. This information can be accessed at: http://www.medicare.gov/hospitalcompare/
Patient satisfaction in the hospital setting is measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (“HCAHPS”) score. HCAHPS scores are patient satisfaction scores that were developed by the Agency for Healthcare Research and Quality (“AHRQ”). These HCAHPS scores are used to calculate the Patient Experience portion of the TPS. HCAHPS scores measure quality pertaining to the following: communication with nurses and doctors, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness and quietness of hospital environment, overall rating of the hospital and whether or not the patient would recommend the hospital. HCAHPS data submissions for patients discharged in October, November and December 2012 should be submitted to the QualityNet website by April 3, 2013.
If you have any questions, please contact Gregg M. Wallander at 317.977.1431 or gwally@hallrender.com or your regular Hall Render attorney.
Special thanks to Alyssa James, Law Clerk, for her assistance with the preparation of this Health Law News article.
