Value-Based Purchasing: How much of a Piece will HCAHPs Play?

There is a lot of buzz within the healthcare industry about the major changes coming from government initiatives. One of those initiatives is value-based purchasing (VBP), a program that will monetarily reward those hospitals that provide Medicare patients with the highest quality of care.  While there are a number of metrics that will be used to determine what this “highest quality of care” is (a complete list of the metrics is available here) one of those metrics that really stands out is HCAHP scores. According to the Centers for Medicare & Medicaid Services VBP proposal HCAHP scores will account for 30% of the total score for VBP. [1]

In September 2011, HealthLeaders Media released an Impact Analysis on Value-Based Purchasing report that really illustrates just how large of a piece the HCAHP scores will play in VBP. (Download the full HealthLeaders report here.)

Almost 180 healthcare leaders participated in this survey. When asked “which particular measure do you expect the most difficulty in reaching improvement or performance initiatives?” 50% of those responding identified HCAHPs as the VBP measure that would provide them with the most difficulty. Heart failure came in a distant second with 16% of respondents.

Not only do HCAHPs play a major part in VBP reimbursement, it would seem that for the majority of hospitals HCAHPs are also the most challenging measure when looking at VBP.

  “VBP is a zero-sum game—out of necessity there will be winners and losers.”
James F. Doyle, Senior Vice President and CFO, Elmhurst (IL) Memorial Healthcare [2]

With Medicare reimbursements soon to be driven by how well a hospital compares to other hospitals, it is inevitable that there will be hospitals that end up with the short end of this stick.  Whenever a ranking system is utilized there will be a full spectrum – on one end, those with the higher scores – and the other end, those with the lower scores.  Unfortunately, in regards to VBP this means some hospitals would receive full reimbursements, while others would receive only partial reimbursements.

In light of these coming changes, the focus should not be “is our hospital going to be one of those VBP winners?” but rather “what are we doing and what else can we do to obtain the VBP ranking we need for financial security?”.  

 David McParland   

877-773-4473 ext. 700