Value Based Purchasing (VBP) Program FY 2015 Measures

on Monday, 25 March 2013. All News Items | Quality

On March 14, 2013, the Centers for Medicare and Medicaid Services (CMS) hosted a National Provider Call providing an overview of Hospital Value-Based Purchasing (VBP) for Fiscal Year (FY) 2015. Before reviewing the finalized domains and measures/dimensions let’s take a quick look back at the background of the VBP Program, how hospitals get scored and how the program is funded.

VBP Program Background:

The VBP program final rule was released April 29, 2011 and at that time CMS indicated in a VBP Program Fact Sheet that “for the first time, hospitals across the country will be paid for inpatient acute services based on care quality, not just the quantity of the services they provide.”

How Hospitals gets Scored:

CMS will score a hospital based on Achievement and Improvement ranges for each measure. Each measure’s score will be based on the higher of the Achievement Score or Improvement Score for that Measure for the Performance Period.

  • Achievement Scores will “be based on how much their current performance differs from all other hospitals’ baseline performance period.”
  • Improvement Scores will be specific to the hospital and “based on how much their current performance changes from their own baseline performance period.”

CMS calculates a Total Performance Score (TPS) for each hospital by combining the greater of its achievement or improvement points on each measure to determine a score for each domain.

Funding for VBP:

Per a VBP Frequently-asked-Question (FAQ), “incentive payments to hospitals will come from the regular fees Medicare pays hospitals through its Diagnosis-Related Group (DRG) system. Hospitals participating in Hospital VBP will have their base operating DRG payments for each patient discharge across all hospitals reduced by a small percentage each year. That money will be used to fund incentive payments for hospitals participating in Hospital VBP.”

The “small percentage each year” is:

  • 1% in Fiscal Year (FY) 2013,
  • 1.25% for FY 2015,
  • 1.5% for FY 2015,
  • 1.75% for FY 2016; and
  • 2% for FY 2017 and subsequent years.

Prior to FY 2015, the VBP Program incentives were based on three domains. For FY 2015 the Efficiency Domain has been added to the Program and includes one measure for FY 2015. Hospital specific results for all four domains are publically available on the Hospital Compare website.

Clinical Process of Care Measures, more widely known as Core Measures, make up 20% of a hospital’s Total Performance Score. These measures can be found under the Timely & Effective Care tab on Hospital Compare. The FY 2015 Clinical Process of Care Measures includes:

Clinical Process of Care Measures for FY 2015

1. AMI-7a Fibrinolytic Therapy Received within 30 Minutes of Hospital Arrival

2. AMI-8a Primary PCI Received within 90 minutes of Hospital Arrival

3. HF-1 Discharge Instructions

4. PN-3b Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital

5. PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patient

6. SCIP-Inf-1 Prophylactic Antibiotic Received within One Hour Prior to Surgical Incision

7. SCIP-Inf-2 Prophylactic Antibiotic Selection for Surgical Patients

8. SCIP-Inf-3 Prophylactic Antibiotics Discontinues within 24 Hours After Surgery End Time

9. SCIP-Inf-4 Cardiac Surgery Patients with Controlled 6 a.m. Postoperative Serum Glucose

10. SCIP-Inf 9 Urinary Catheter Removed on Postoperative Day 1 or Postoperative Day 2

11. SCIP-Card-2 Surgery Patients on Beta-Blocker Therapy Prior to Arrival Who Received Beta-Blocker During the Perioperative Period

12. SCIP-VTE-2 Surgery Patients Who Received Appropriate Venous Thromboembolism Prophylaxis within 24 Hours Prior to Surgery to 24 Hours After Surgery

 

Patient Experience of Care Dimensions make up 30% of a hospital’s Total Performance Score. These Care Dimensions can be found under the Patient Survey Results tab on Hospital Compare. The survey reported on Hospital Compare is the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). This survey is a national survey that asks patients about their experiences during a recent hospital stay. Specific Patient Experience of Care Dimensions included in the VBP Program includes:

 

Patient Experience of Care Dimensions for FY 2015

1. Communication with Nurses

2. Communications with Doctors

3. Responsiveness of Hospital Staff

4. Pain Management

5. Communication about Medicines

6. Cleanliness and Quietness of Hospital Environment

7. Discharge Information

8. Overall Rating of Hospital

 

Outcome Measures make up 30% of a hospital’s Total Performance Score. There are two new Outcome Measures for the FY 2015 program (see Outcome Measures for FY 2015 table). Mortality rates for Acute Myocardial Infarction, Heart Failure, Pneumonia and Central Line-Associated Blood Stream Infections data can be found under the Readmissions, Complications & Deaths tab on Hospital Compare. At this time not all Patient Safety Indicators are available for public viewing.

 

Outcome Measures for FY 2015

1. AHQR (PSI-90) Patient Safety for Selected Indicators (Composite) - NEW Measure FY 2015

Composite Measures

PSI 03 - Pressure Ulcer Rate

PSI 06 - Iatrogenic Pneumothorax Rate

PSI 07 - Central Venous Catheter-Related Bloodstream Infection Rate

PSI 08 - Postoperative Hip Fracture Rate

PSI 12 - Postoperative Pulmonary Embolism or Deep Vein Thrombosis Rate

PSI 13 - Postoperative Sepsis Rate

PSI 14 - Postoperative Wound Dehiscence Rate

PSI 15 - Accidental Puncture or Laceration Rate

2. CLABSI Central Line-Associated Bloodstream Infection - NEW Measure for FY 2015

3. MORT-30-AMI Acute Myocardial Infarction (AMI) 30-day mortality rate

4. MORT-30-HF Heart Failure (HF) 30-day mortality rate

5. MORT-30-PN Pneumonia (PN) 30-day mortality rate

 

A new Efficiency Measure has been added to the FY 2015 Program.

Efficiency Measure for FY 2015

1. MSPB-1 Medicare spending per beneficiary - NEW Measure for FY 2015

 

This Medicare Spending per beneficiary (MSPB) measure will make up 20% of a hospital’s Total Performance Score. According to CMS the MSPB measure is “a claims-based measure that includes risk-adjusted and price-standardized payments for all Part A and Part B services provided from 3 days prior to a hospital admission (index admission) through 30 days after the hospital discharge.” Data for this measure was posted on Hospital Compare in April 2012 and can be found under the Medicare Payment tab. To learn more about this measure access the February 29, 2012 Medicare Spending per Beneficiary National Provider Call.

 

Baseline and Performance Periods for FY 2015 Scoring

 

FY 2015 Baseline and Performance Periods

 

 

Baseline Period

Performance Period

Clinical Process & Patient Experience Domains

Core Measures & HCAHPS

January 1, 2011 - December 31, 2011

January 1, 2013 - December 31, 2013

Outcome Domain

Mortality Measure

October 1, 2010 - June 30, 2011

October 1, 2012 - June 30, 2013

AHQR - Patient Safety Composite Measure

October 15, 2010 - June 30, 2011

October 15, 2012 - June 30, 2013

CLABSI - Central Line Associated Bloodstream Infection

January 1, 2011 - December 31, 2011

February 1, 2013 - December 31, 2013

Efficiency Domain

MSPB - Medicare Spending Per Beneficiary

May 1, 2011 - December 31, 2011

May 1, 2013 - December 31, 2013

 

As you can see, we are at a point in the Performance Period that will affect your FY 2015 incentives.

Additional information regarding the VBP Program can be found at www.cms.gov/Hospital-Value-Based-Purchasing

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Director of Clinical Services at Medical Management Plus, Inc. Beth has over twenty-two years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth monitors, interprets and communicates current and upcoming Case Management / Clinical Documentation issues as they relate to specific entities concerning Medicare. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

 

 

>

green-iconWe are an environmentally conscious company, dedicated to living “green” both at work and as individuals.

Location

home-icon
1900 Twentieth Avenue South
Suite 220
Birmingham, AL 35209

Connect

phone
205-941-1105
phone
800-592-9639
email
This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 mhms