3 ways hospitals can get most from value-based purchasing

Organizations are beginning to recognize the importance of value-based purchasing. However, one misconception, of this mandatory program under the Patient Protection and Affordable Care Act is that it's something that can be worried about next year.

"Today we're actually in the measurement process for fiscal year 2014. Measurement and payments have already been determined for 2013," said Dave Rhew, MD, senior vice president and chief medical officer of Zynx Health, a company that provides evidence-based clinical decision support solutions to help improve patient outcomes and lower costs. What's being recognized is that what happens today is impacting payments two years down the road. That's the immediate connection not being made,"

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The other thing organizations are just starting to get a grip on is how exactly the program works, said Rhew.

Measurement for fiscal year 2013 is broken into two domains: the 12 clinical process of care measures and the eight patient experience of care dimensions.

"What they've done for fiscal year 2014 - what we're measuring today - is that they've added an additional clinical process, totaling 13, and added three measures that assess mortality outcomes related to heart attack, heart failure and pneumonia," Rhew said.

For fiscal year 2015, CMS is looking to add another clinical process of care measure, two more outcomes (with a specific focus on patient safety events) and an additional metric under the new domain of efficiency. This new efficiency metric is defined as Medicare spend per beneficiary, starting three days prior to hospitalization and ending 30 days post-discharge. The lower the spend, the higher the efficiency score.

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"Every hospital is then rated on a linear scale where top performers get the highest level of reimbursement and bottom performers do not earn back their payments," explained Rhew. "The program is set up so you have to put in money starting at 1 percent for 2013, 1.25 percent for 2014, 1.50 percent for 2015, 1.75 percent for 2016, and 2 percent for 2017 and subsequent years. For fiscal year 2013, you need to score higher than 41.6 percent to break even, while those folks under the mark will not."

Rhew shared with Healthcare IT News three key ways hospitals can ensure a positive financial impact of value-based purchasing.