CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2019
By Frank Miceli, Partner, Assurance Services
The Hospital Value-Based Purchasing Program (VBP) is entering its seventh year and is one of many programs Medicare has established to reimburse providers for quality instead of quantity. Under this program for fiscal year (FY) 2019, a portion of the base operating Diagnosis-Related Group (DRG) payment amounts are reduced by two percent with the total of these reductions to be reallocated to participating hospitals based on the results of a set of quality and cost measures. CMS estimates the total amount available from these reductions for value-based incentive payments in FY 2019 will be approximately $1.9 billion.
The actual amount of incentive payments earned back by participating hospitals will depend on the following three values:
- Each hospital’s Total Performance Score (TPS).
- Each hospital’s value-based incentive payment percentage.
- Estimated FY 2019 amount available for value-based incentive payments.
Hospitals may earn back an increase, receive a decrease, or have no change to their Medicare IPPS payments for the applicable fiscal year.
The 2019 Total Performance Score (TPS) for each hospital is based on four measurement domains, which are (1) clinical care, (2) safety, (3) person and community engagement, and (4) efficiency and cost reduction. Hospitals must have a domain score for at least three of the four measurement domains in order to have a TPS calculated. Hospitals that do not meet the minimum domain requirements do not have their payments adjusted in the corresponding fiscal year. For every measure, each participating hospital receives an achievement score (based on how well it performed compared to other hospitals) and an improvement score (based on how much it improved over time); the higher of the two scores is awarded as the measure score.
The performance standards for the four domains for FY 2019 are based on the following:
Clinical Care Domain
Mortality Measures
Baseline Period: July 1, 2009 – June 30, 2012
Performance Period: July 1, 2014 – June 30, 2017
Complication Measures
Baseline Period: July 1, 2010 – June 30, 2013
Performance Period: January 1, 2015 – June 30, 2017
| Measure ID | Measure Description | Benchmark | Achievement Threshold |
|---|---|---|---|
| MORT-30-AMI | Acute Myocardial Infarction (AMI) 30-Day Mortality Rate | 0.873263 | 0.850671 |
| MORT-30-HF | Heart Failure (HF) 30-Day Mortality Rate | 0.908094 | 0.883472 |
| MORT-30-PN | Pneumonia (PN) 30-Day Mortality Rate | 0.907906 | 0.882334 |
| COMP-HIP-KNEE | Total Hip Arthroplasty (THA)/Total Knee Arthroplasty (TKA)Complication Rate | 0.023178 | 0.032229 |
Person and Community Engagement Domain
Baseline Period: January 1 – December 31, 2015
Performance Period: January 1 – December 31, 2017
| Dimension | Benchmark | Achievement Threshold | Floor |
|---|---|---|---|
| Communication with Nurses | 86.97% | 78.69% | 28.10% |
| Communication with Doctors | 88.62% | 80.32% | 33.46% |
| Responsiveness of Hospital Staff | 80.15% | 65.16% | 32.72% |
| Communication about Medicines | 73.53% | 63.26% | 11.38% |
| Cleanliness and Quietness of Hospital Environment | 79.06% | 65.58% | 22.85% |
| Discharge Information | 91.87% | 87.05% | 61.96% |
| Care Transition | 62.77% | 51.42% | 11.30% |
| Overall Rating of Hospital | 84.83% | 70.85% | 28.39% |
Safety Domain
Baseline Period: January 1 – December 31, 2015
Performance Period: January 1 – December 31, 2017
| Measure ID | Measure Description | Benchmark | Achievement Threshold |
|---|---|---|---|
| CAUTI | Catheter-Associated Urinary Tract Infection | 0.000 | 0.822 |
| CDI | Clostridium difficile Infection | 0.113 | 0.924 |
| CLABSI | Central Line-Associated Blood Stream Infection | 0.000 | 0.860 |
| MRSA | Methicillin-Resistant Staphylococcus aureus | 0.000 | 0.854 |
| PC-01 | Elective Delivery Prior to 39 Completed Weeks Gestation | 0.000000 | 0.010038 |
| SSI | SSI – Abdominal Hysterectomy SSI – Colon Surgery | 0.000 0.000 | 0.762 0.783 |
Efficiency and Cost Reduction Domain
Baseline Period: January 1 – December 31, 2015
Performance Period: January 1 – December 31, 2017
| Measure ID | Measure Description | Benchmark | Achievement Threshold |
|---|---|---|---|
| MSPB | Medicare Spending per Beneficiary | Mean of the lowest decile Medicare Spending Per Beneficiary ratios across all hospitals during the performance period. | Median Medicare Spending Per Beneficiary ratio across all hospitals during the performance period. |
Definitions
- Baseline Period
- The time period during which data are collected for the purpose of calculating hospital performance on measures to establish the improvement thresholds for each measure with respect to a fiscal year.
- Performance Period
- The time period during which data are collected for the purpose of calculating hospital performance on measures with respect to a fiscal year.
- Benchmark
- For clinical care, person and community engagement and safety, the benchmark represents the mean of the top decile of all hospitals’ performance for each measure during the baseline period.
- Achievement Threshold
- For clinical care, person and community engagement and safety, the achievement threshold marks the 50th percentile of all hospitals’ performance for each measure during the baseline period.
CMS has posted the Hospital VBP Program incentive payment adjustment factors for each participating hospital for FY 2019 in Table 16B at www.cms.gov.
For FY 2019, 2,786 hospitals are participating in the program, and 1,229 of those hospitals will receive a net reduction to their payments with an average reduction of 0.39% and the lowest performing hospital receiving a reduction of 1.59%. For the hospitals receiving an increase, the average increase to their payments are approximately 0.61% with the highest performance hospital receiving an increase of 3.67%.
Additional Information
For more information on the Hospital VBP Program, visit the CMS website at www.cms.gov and the QualityNet website at www.qualitynet.org
