Expert response provided by:
Nancy Hudecek, RN, BSN, MS
Director, Patient Safety and Quality Improvement, HealthStream
The healthcare reform debate is certainly heated. There are a number of "who" items in contention such as payer structure, eligibility, and coverage. A number of plans have been proposed in both the House and Senate. We looked at the impact of current legislation and the proposals to date relative to the issues of pay for reporting (P4R), pay for performance (P4P) and Value-Based Purchasing (VBP) and several themes emerged.
For fiscal year (FY) 2010, we are still in "P4R" mode. That is, hospitals that participate in the Inpatient Prospective Payment System (IPPS) who wish to receive their full annual payment update (RHQDAPU) must continuously collect and submit all 44 hospital quality data elements in accordance with CMS guidelines, including HCAHPS. As we look to the future, the legislation and underlying plans propose transitioning away from pay for reporting and toward pay for performance and value-based purchasing.
While the approaches differ with the various bills, there is universally a "when" (when VBP will take effect), a "what" (which monies will be impacted), and a "how much of the what" (what percentage of the at risk monies will be at risk). We cannot predict the future, but implementation dates for VBP range from 2011 to 2013 (ramping up to full impact by 2016). Whether the APU or some percent of the DRG will be at risk is at the heart of the "what" debate and, at present, the penalty or "how much of the what" ranges from 5% to 15%.
To help stratify performance and reimbursement, most of the proposals suggest a baseline performance measure be calculated nationally, with an opportunity to earn additional revenue based upon improvement over the baseline. The idea is to categorize performance into levels to allow for differences in reimbursement based upon performance. For example, one plan suggests hospitals scoring in the top 75th percentile nationally would achieve the maximum reimbursement, mid-range performers would be rewarded a percentage commensurate with their respective percentiles and the lowest performers would receive the maximum revenue penalty.
HealthStream recommends the lowest performers nationally target the 50th percentile. Once that benchmark is achieved, target the top 75th percentile nationally. Ultimately, to maximize reimbursement your organization will want to be at the top 95th percentile nationally in all measures. HealthStream has developed some tools and methods for helping hospitals understand and make the business case around performance improvement in all 44 areas. Contact your account manager for assistance.
For more information, here are the best currently available resources for VBP:
· http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3485&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
· http://finance.senate.gov/sitepages/leg/LEG%202009/042809%20Health%20Care%20Description%20of%20Policy%20Option.pdf
· http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/HospitalVBPPlanRTCFINALSUBMITTED2007.pdf
· http://www.hcahpsonline.org/executive_insight/default.aspx
· http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalRHQDAPU200808.pdf
· http://www.qualitynet.org/dcs/ContentServer?cid=1138115987129&pagename=QnetPublic%2FPage%2FQnetTier2&c=Page
· http://edocket.access.gpo.gov/2008/pdf/E8-17914.pdf
· http://edocket.access.gpo.gov/2009/pdf/E9-10458.pdf
· http://www.cms.hhs.gov/HospitalQualityInits/Downloads/HospitalHCAHPSFactSheet200807.pdf
· http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf
· http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf
· http://docs.house.gov/rules/health/111_ahcaa.pdf