Early Performance of Hospital Value-based Purchasing Program in Medicare

Abstract

Background: Under the Affordable Care Act, the Centers for Medicare and Medicaid Services has greatly expanded inpatient fee-for-value programs including the Hospital Value-based Purchasing (HVBP) program. Existing evidence from the HVBP program is mixed. There is a need for a systematic review of the HVBP program to inform discussions on how to improve the program’s effectiveness. Objective: To review and summarize studies that evaluated the HVBP program’s impact on clinical processes, patient satisfaction, costs and outcomes, or assessed hospital characteristics associated with performance on the program. Design: We searched the MEDLINE/PubMed, Scopus, ProQuest database for literature published between January 2013 and July 2019 using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: Of 988 studies reviewed, 33 studies that met the selection criteria were included. A small group of studies (n=7) evaluated the impact of the HVBP program, and no impact on processes or patient outcomes was reported. None of the included studies evaluated the effect of HVBP program on health care costs. Other studies (n=28) evaluated the hospital characteristics associated with HVBP performance, suggesting that safety-net hospitals reportedly performed worse on several quality and cost measures. Other hospital characteristics’ associations with performance were unclear. Conclusions: Our findings suggest that the current HVBP does not lead to meaningful improvements in quality of care or patient outcomes and may negatively affect safety-net hospitals. More rigorous and comprehensive adjustment is needed for more valid hospital comparisons.

Association of Patient-Provider Teach-Back Communication with Diabetic Outcomes: A Cohort Study

“…The value-based program models are designed to incorporate patient-centered outcomes to improve the quality of care and incentivize providers in a reliable and effective way. [38][39][40] The present study found that the teach-back method during the interaction between a patient and provider achieved favorable patient outcomes. However, only 25% of the patient population with diabetes had consistent teach-back experience during their visits to care.…”

Combined impact of Medicare’s hospital pay for performance programs on quality and safety outcomes is mixed

“…and a disproportionate burden on safety net providers [8] Similarly, the impact of HVBP and HACRP is not promising. Multiple studies have examined the impact of HVBP [9]; most found no impact on a wide range of targeted quality metrics, with modest evidence of improvements in pressure ulcers [10] and 30-day pneumonia mortality rates [11]. Early studies of the HACRP suggested improvements in hospitalacquired conditions, [12] but more recent studies suggest there is no clear relationships between receipt of HACRP penalties and hospital quality of care [13,14].…”

Minimally important difference in cost savings: Is it possible to identify an MID for cost savings?

“…Concern about the growing spending trend in healthcare (Dieleman et al 2020) has prompted clinical and health policy decision makers to continually assess benefits and value of new treatments and care processes with an objective to control costs without sacrificing quality of care (Blumethal and Abrams 2020;Baicker and Chandra 2020). Rising healthcare costs are a national problem, and as part of efforts to control costs, studies to assess the effect of systems changes on costs abound (Hong et al 2020;Farford et al 2019). However, few cost studies report a formal power analysis, and the literature is silent on questions related to the magnitude of cost.…”