Addressing hospital value based purchasing complexity

By Harshad Patil
08:53 AM

As healthcare expenditures continue to rise, the Centers for Medicare and Medicaid Services are moving away from traditional fee-for-service reimbursements to outcome driven models, such as the Hospital Value Based Purchasing (HVBP) program, which rewards healthcare organizations financially for providing higher quality of care to Medicare patients.

The financial Impact of HVBP on non-performing hospitals will be significant. Since the best performing hospitals win the dollar share of those that are non-performing, participating organizations stand the chance of losing money to regional competitors who are doing well. This can directly impact bottom lines and their ability to take on new safety or efficiency initiatives.

Over the next few years, the HVBP program will start including outcome and efficiency measures, covering a much wider range of data sources and more complex requirements around outcome-based processes and clinical efficiency. To manage these changes, hospitals need to adopt a standardized way to not just calculate HVBP scores, but also to incorporate the new types of data that are needed to track and report performance. Healthcare analytics tools are capable of reducing much of the complexity involved in clinical, financial and operational reporting and performance management.

Simplifying HVBP Calculations

Some hospitals are already tracking reporting data manually, but this can be time consuming and inflexible. To be truly successful in this new environment, organizations will need to invest in a robust, HVBP-ready analytics solution. These allow hospitals to track their current scores compared to thresholds and benchmarks, identify improvement areas, and maximize incentives by continuous improvement. In fact, some solutions actually come pre-built with a suite of HVBP measures that can be integrated within a matter of weeks.

Not only will an analytics solution help with these actions, but hospitals that invest in a powerful rules engine, clinical data repository and reporting tools also get the advantage of various other tools such as those for IQR, Meaningful Use, The Joint Commission, the Medicare Shared Savings Program as well as internal operational and financial metrics.

Integrating Diverse Data Sources

In 2014, participating organizations were only being evaluated on two domains: the clinical process of care and the patient experience of care. However, in 2015 the domains will grow from two to four. These new measures will cover a much wider range of data sources and more complex requirements around outcome-based processes and clinical efficiency. While hospitals may have been able to get by with other reporting functions in previous years, advanced functionality will be needed to address the new domains of outcomes and efficiency. The data needed to calculate the performance score for these new measures will come from a variety of disparate data sources, such as patient registration, electronic medical records, department systems, patient accounting and billing systems, and internal feedback systems. In a typical hospital environment these are all provided by multiple vendors, making integration more difficult.

Vendor agnostic analytics solutions have the Extract-Transform-Load (ETL) capabilities to aggregate and cleanse clinical, financial and patient satisfaction data from these source systems and reconcile it to form a longitudinal patient record, which can then be used to drive the rules needed for HVBP calculations. Real-time data integration from source systems will ensure that the calculations remain current and provide an accurate reflection of the organization’s health.