The Hospital Value-Based Purchasing (VBP) Program was implemented under the Affordable Care Act to improve hospital patients’ clinical outcomes and satisfaction of care experience, as well as reduce health care costs. Hospitals will be given incentive payments based on their overall performance on a set of quality measures that have been linked to improved clinical processes of care and patient satisfaction.
Why the Need for Hospital Care Improvement?
Hospital payments account for the largest share of Medicare spending, and Medicare is the largest single payer for hospital services. In 2009, more than 7 million Medicare beneficiaries experienced more than 12.4 million inpatient hospitalizations, reports the U.S. Department of Health and Human Services. One in seven Medicare patients will experience some “adverse” event such as a preventable illness or injury while in the hospital, while one in three Medicare beneficiaries who leave the hospital today will be back in the hospital within a month. Every year, as many as 98,000 Americans die from errors in hospital care.
These errors lead to significant and unnecessary health care spending. Medicare spent an estimated $4.4 billion in 2009 to care for patients who had been harmed in the hospital, and readmissions cost Medicare another $26 billion.
Examples of the care processes included in the measures are:
How quickly do heart attack patients receive potentially life-saving surgery on their arteries?
Hospital Value-Based Purchasing will measure how quickly doctors perform procedures known as Percutaneous Coronary Interventions (PCIs), which are among the most effective ways to open blocked blood vessels that cause heart attacks. Doctors may perform PCI, or give medicine to open the blockage, and in some cases, may do both. Quick and effective PCI can prevent a heart attack from occurring, or can prevent a heart attack from worsening or recurring. This leads to better outcomes for patients and lower health care costs.
How often do surgery patients receive the right treatment at the right time to prevent blood clots?
Hospital Value-Based Purchasing will measure how often patients having certain kinds of surgery received treatment to prevent blood clots from forming in the 24-hour period before and after surgery. The right treatment at the right time can protect surgical patients from developing potentially fatal blood clots or suffering costly complications.
How often do patients with heart failure get the discharge instructions they need to care for themselves?
Heart failure patients are more likely to be readmitted to the hospital within 30 days than many other types of patients. One reason is that patients with heart failure usually leave the hospital with many new medications and treatment regimens. Knowing how best to care for themselves once they leave the hospital can keep heart failure patients at their healthiest, and can avoid the costly and stressful experience rehospitalization. Hospital Value-Based Purchasing will measure how often hospital staff provide heart failure patients with the information they need to manage their symptoms after their hospital stay.
How satisfied are patients with their experience of care at the hospital?
Positive patient experiences mean that patients feel comfortable and safe while in the hospital, and feel that they have the information they need to continue to heal after leaving the hospital. These measures reflect what thousands of patients have said on surveys about their perceptions of health care in thousands of hospitals across the country.
A full list of the measures is available here.
Beneficiaries and consumers are encouraged to learn more about the Hospital Value-Based Purchasing Program on Medicare’s Hospital Compare website.