Value-Based Purchasing, Efficiency, and Hospital Performance

Abstract

The Medicare hospital value-based purchasing (HVBP) program that links Medicare payments to quality of care became effective in 2013 in the United States. Hospital efficiency will be added to the HVBP in 2015. It is unclear whether hospital efficiency-specific hospital characteristics are associated with HVBP performance scores and the subsequent incentive payments. Using data from the American Hospital Association Annual Survey the Medicare Hospital Compare, this article examines the association of hospital efficiency hospital characteristics with the HVBP performance scores. The results indicate that less efficient hospitals are more likely to have lower patient satisfaction scores and total performance scores compared with more efficient hospitals. Hospital size, ownership, and payer mix also have significant impact on HVBP performance scores. The findings of this study provide significant policy practice implications. On the one hand, hospitals should consider investing their limited resources into identifying implementing the most cost-effective procedures to improve their patient experience total performance scores. On the other hand, policymakers should consider the unintended negative impact that these new payment incentives will likely have on hospitals that serve a higher proportion of low-income racial ethnic minority populations.

Design and effects of outcome-based payment models in healthcare: a systematic review

“…Private providers and providers with low baseline quality scores improved their performance the most (Hudson Health plan, MSSP, Pioneer ACO, QOF, VBP, VIP) [ 45 , 59 , 60 , 71 , 81 – 84 ], although some studies concerning the VBP report relatively poor performance of initially low-scoring providers, and in HQID safety net hospitals performed relatively poorly [ 9 , 61 – 63 , 67 , 79 , 80 ]. Among the narrow OBPMs, three models (HQID, Hudson Health plan, QOF) show that large providers outperform smaller ones [ 30 , 60 , 85 ].…”

“…Among the narrow OBPMs, three models (HQID, Hudson Health plan, QOF) show that large providers outperform smaller ones [ 30 , 60 , 85 ]. In the VBP model, this scale effect is mixed [ 83 , 84 , 86 ].…”

“…In the QOF, quality of care for diabetics with co-morbidities improved more than for those without co-morbidities [ 87 ]. In contrast, mental health centres (AQC), nursing homes (QOF), and hospitals with more Medicare and Medicaid patients (VBP) showed significantly lower quality scores after introduction of a OBPM [ 49 , 51 , 84 , 88 ]. In the Hudson Health Plan, there was no change in quality of care for patients both with and without co-morbidities [ 34 ].…”

Hospital value based purchasing scores highly associated with prior year score and organizational characteristics

“…Prior research, as well as the descriptive statistics in Table 1, also suggested that hospitals with academic status were at a disadvantage. [13,20] Given these findings, academic hospitals, or other large hospitals that provide care for the underserved, or both, may be disadvantaged in the HVBP program.…”

Total Visual System Assessment—Integrating Wavefront Technology in Refractive Examinations

“…It is also desirable that the technology be appealing and impressive to patients and their caregivers. 5,13,[17][18][19] Quality of outcome is not determined by merely asserting the novelty of an instrument or therapeutic modality. It is necessary to ask what incremental benefit might be expected relative to performance and cost of this technology when compared to competing products.…”