How Total Performance Scores of Medicare Value-Based Purchasing Program Hospitals Change Over Time. Issue 2 (31st March 2022)

• Record Type: Journal Article
• Authors: Ramirez, Adriana G.; Marsh, Katherine M.; McMurry, Timothy L.; Turrentine, Florence E.; Tracci, Margaret A.; Jones, Rayford S.
• Is Part Of: Journal for healthcare quality. Volume 44:Issue 2(2022)
• Page Start: 78
• Page End: 87
• Publication Date: 2022-03-31
• Subjects: value-based purchasing -- incentive reimbursement -- healthcare evaluation mechanisms -- quality of healthcare -- healthcare reform; Medical care -- Quality control -- Periodicals; Quality assurance -- Periodicals; 362.1
• DOI: 10.1097/JHQ.0000000000000321
• Languages: English
• ISSNs: 1062-2551

Abstract

Abstract : Supplemental Digital Content is Available in the Text. ABSTRACT: Background and Purpose: The Medicare Value-Based Purchasing (VBP) program established performance-based financial incentives for hospitals. We hypothesized that total performance scores (TPS) would vary by hospital type. Methods: Value-Based Purchasing reports were collected from 2015 to 2017 and merged with the Centers for Medicare and Medicaid Services (CMS) Impact File data. A total of 3, 005 hospitals were grouped into physician-owned surgical hospitals (POSH), accountable care organizations (ACO), Kaiser, Vizient, and General hospitals. Longitudinal linear mixed-effects models compared temporal differences of TPS and secondary composite outcome, process, patient satisfaction, safety, and cost efficiency measures between hospital types. Results: Total performance scores decreased across all hospital types ( p < .001). Physician-owned surgical hospitals had the highest TPS (59.9), followed by Kaiser (49.2), ACO (36.7), General (34.8), and Vizient (30.7) ( p < .001). Hospital types differed significantly in size, geography, mean case-mix index, Medicare patient discharges, percent Medicare days to inpatient days, Disproportionate Share Hospital payments, and uncompensated care per claim. Scores improved in 84% of POSH and 14.6% of Kaiser hospitals using score reallocations. Conclusion: In comparison with General hospitals, the TPS was higher for POSH and Kaiser and lower for Vizient in part due to weighting reallocation and individual domain scores. Implications: Centers for Medicare and Medicaid Services scoring system changes have not addressed the methodological biases favoring certain hospital types.