Value - Based Purchasing Presented by Kyle Bain For Kemal Erkan HCM-401 Course

 Definition & Factors  Critical Quality Measures  Calculations  Incentive Percentage Changing the Behavior

 Definition & Factors  Critical Quality Measures  Calculations  Incentive Percentage Changing the Behavior

 Definition  A Payment Reform under which Hospitals and other Providers are provided Bonuses based upon their performance against Quality Measures  Ranking and “Achievement Score” is based on Comparison and Improvements to a “Base-Line”  Factors (aka Domains) 1. Clinical Process of Care 2. “Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey” Changing the Behavior

 Definition & Factors  Critical Quality Measures  Calculations  Incentive Percentage Changing the Behavior

 “Clinical Process of Care” - 5 Specific Conditions 1. Acute Myocardial Infarction 2. Heart Failure 3. Pneumonia 4. Surgeries 5. Healthcare Associated Infections  “HCAHPS Survey” (Patient Survey)  1 Year Performance Period  First year based on ¾ of the fiscal year Changing the Behavior

 Definition & Factors  Critical Quality Measures  Calculations  Incentive Percentage Changing the Behavior

 CMS will Reduce Hospitals’ base Diagnosis Related Group (DRG) payments by 1% in 2013  2% in 2017 and beyond  Redistribution of about $850 Million  Hospitals in the Highest Percentile receive the Largest Incentive ▪ Top 25% = Incentive ▪ Bottom 25% = Penalty Changing the Behavior

 Definition & Factors  Critical Quality Measures  Calculations  Incentive Percentage Changing the Behavior

 Incentives  Top 95 th =.3% to.6% Bonus  Top 90 th =.3% to.4% Bonus  Top 75 th =.1% to.3% Bonus  Middle 50 th – No Bonus or Penalty  As required by law, all scores will be published on the “Hospital Compare” website  Hospital’s Domain-Specific Score  Hospital’s Condition Specific Score  Total Performance Score Changing the Behavior

Questions? Changing the Behavior