The CMS Value-Based Purchasing Program: Making Sense of the Regulations and Implications for Health System Pharmacy

Abstract

The Director's Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on the Center for Medicare & Medicaid Service's (CMS) Value-Based Purchasing (VBP) program for hospitals. VBP links Medicare payments to the quality performance of acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), for patient assigned to various diagnosis-related groups (DRGs). It is essential that pharmacy directors understand the implications of the VBP program and the subsequent opportunity that it creates for pharmacy. To take full advantage of the program, adjustments will need to be made in staffing, skill mix, and ultimately the design of the pharmacy practice model.

Introductory Chapter: Developing Patient Safety Champions

“…Furthermore, payers are now looking toward financial models that consider not only the patient outcomes but provider-and institution-specific outcomes as well [16,17]. Within the value-based healthcare paradigm, unusually high wound infection rates or failures to use (or even document the use) of best-practice therapies such as prophylactic antibiotics, pre-procedural beta-blockers, and appropriate DVT prophylaxis are now becoming publically reported data and potential quality metrics for which insurance payers might withhold or adversely adjust payments [18,19]. In some situations, failure to use or document "best practices" that are focused on patient safety can even result in institutional financial and nonfinancial penalties [20,21].…”