More than 3,000 hospitals across the nation participate in the Value Based Purchasing Program, created by the Affordable Care Act. But what is it and what does that mean for you?

The Value Based Purchasing Program is a program designed to increase the quality of care for Medicare patients. The general premise is simple: acute-care hospitals are rewarded for higher quality care for Medicare patients. The incentive measures the quality of best-practice treatment and, based on a hospital’s performance period (or increase in performance), it will be rewarded proportionately. There are different incentives for achieving Quality Initiatives and Quality Improvements, and hospitals are based on both previous benchmarks and national achievement thresholds.

The VBP doesn’t apply to everyone, however; there are exceptions, such as “psychiatric, rehabilitation, long-term care, children’s and cancer hospitals,” (cms.gov) hospitals that don’t participate during the IQR (Inpatient Quality Reporting)  period, hospitals that are deficient by the Secretary HHS standards; and finally, hospitals which don’t have the quantitative minimum in terms of cases.

The funding is provided by the standard fees Medicare pays, but Medicare will reduce their base operating pay gradually from 1% in 2013 to 2% in 2017, in increments of .25% percent for the years in between. The savings from these reductions will apply towards the hospitals that score in the higher 50th percentile. Only those above this threshold will receive the incentive. However, the achievement threshold is different from the quality improvement. The improvement measures the improvement performance against a hospital’s baseline performance; in other words, the hospital’s previous performance in key areas.

As for the quality measures, the fiscal year sought 13 separate measures which can be found here (question 32), and range from HCAHPS to blood cultures performed for pneumonia.  However, the measures for procedures which a hospital performs cannot be held against them.

The VBPP, like any new program, certainly presents its challenges unique to its own situation. This is where we come into the equation. At MedPartners HIM, we know health management systems, and we retain the top experts to help with your needs – even on short notice. Contact us today to see how we help benefit your business!