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Learn MoreA Guest Partner Blog from Todd McQueston, Executive Director of Marketing and Business Development, Wolters Kluwer
Value-based Purchasing became a healthcare topic with the implementation of the Patient Protection and Affordable Care Act (ACA) of 2010. Although the Hospital Readmissions Reduction Program has been in the news more often, the Value-Based Purchasing (VBP) program may be more influential to hospital administrators because it provides an opportunity to receive additional payment for services rendered instead of simply penalizing poor performing hospitals.
Part of the Hospital Inpatient Quality Reporting Program, but known as the Hospital Value-Based Purchasing Program, the initiative is one of a handful established by Medicare in recent years to boost the quality of care provided by hospitals (the Hospital Readmissions Reduction Program and the Hospital Acquired Condition Reduction Program are the others most noted in the news).
Based on a complex set of calculations from the base Diagnosis Related Group (DRG) payment, the budget neutral program is funded by CMS withholding a percentage of payments on Medicare claims and then returning all of that money to those hospitals performing the best within the program. Given that 39.7% of a typical US hospital’s total 2012 patient revenue came from Medicare (cited by the American Hospital Association “Trends in Hospital Financing”), there is potentially millions of dollars in difference between the worst performing hospital’s penalty and the top performing hospital’s incentive payment.
So with all this money at stake, what can hospitals do to improve their Value-based Purchasing scores?
Phased in gradually since 2012, the VBP program calculates a Total Performance Score for each hospital that is based on performance in four specific domains:
Working to improve clinical process, patient experience, outcomes, and efficiency is nothing new to health systems. Hospitals spend lots of dollars and resource time implementing hospital-wide change programs (such as the Baldrige Program and the ANCC Magnet Designation Program), tracking and analyzing quality indicators, and responding to specific clinical issues from adverse events, quality tracking, and patient surveys.
Each hospital has its own focus on how to improve. For example, St. Luke’s Hospital in Coaldale, PA, initiated an entire Operational Excellence program that included, among other initiatives, the development of a hospitalist model, Core Measure education and compliance, development and implementation of the Clinical Documentation Specialist, re-structuring of the Case Management Department, development of a Medical Staff Quality Improvement Committee, and development of a Patient Satisfaction Committee.
The Rockburn Institute recently completed a study that found a correlation between hospitals using specific evidence-based clinical decision support and clinical procedural improvement software systems and higher Total Performance Scores for those hospitals in the VBP program. For example, the study, which used all hospitals in the database, indicated that hospitals using Lippincott Procedures for the entire study period have a 12% higher Total Performance Score than hospitals not using Lippincott Procedures. Within this correlation, hospitals using the clinical procedural software showed a 23% higher Clinical Process of Care score than hospitals not using the Procedures product.
Whether hospitals are specifically focusing on improving their VBP scores or simply looking to improve clinical excellence and Patient Outcomes, the overall scores are improving.
According to a December 2014 post on the CMS Blog, “Data from the third year of the program indicates that hospitals are improving care and outcomes for Medicare beneficiaries. More hospitals this year will experience a positive change in their payments (1,714) compared to the number of hospitals that will experience a negative change (1,375) – a reversal of last year. This change indicates that many hospitals are improving the quality of care delivered to patients.”
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validate health outcomes and support provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
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