GAO: Value-Based Purchasing Program Not Linked to Better Quality
Medicare's Hospital Value-Based Purchasing Program has not yet led to increases in care quality overall, according to a report released Thursday by the Government Accountability Office, Kaiser Health News reports (Rau, Kaiser Health News, 10/2).
Under the VBP program, CMS calculates an incentive payment for each hospital based on its performance on quality and patient experience measures, such as patient satisfaction, lower mortality rates and how much Medicare pays for each patient.
Earlier this year, CMS gave performance-based bonuses to nearly 1,700 hospitals and curbed payments to 1,360 hospitals under the program (California Healthline, 1/26).
According to the report, the program's effects on finances and quality have been minimal so far. Nearly three-fourths of hospitals saw their Medicare payments increase or drop by less than half a percentage point for the fiscal year that ended on Sept. 30, according to the report. The median bonus and penalty payments were just $39,000 and $56,000, respectively.
The report also "found no apparent shift in … quality measure trends during the initial years of the program," noting that hospitals were already improving quality measures -- such as following clinical guidelines -- prior to the start of the program in October 2012. Those improvements continued but did not accelerate under the program, the report found.
Variation by Facility Type
Some providers fared better than others under the program. Overall, the report noted that hospitals with a net income margin of more than 5% received a bonus of 0.23%, while those that broke even or ran a deficit generally received no bonus or received penalties (Kaiser Health News, 10/2).
The highest-performing hospitals were specialty facilities with 60 or fewer beds; they earned an average payment bonus of 0.38%. Larger hospitals and safety-net hospitals fared worst under the program, according to the report (GAO report, 10/1).
Despite the findings, GAO said the program could prove more effective over time as "the program implements planned changes," adding that the success of other programs suggest "financial incentives … may, under certain circumstances, promote enhanced quality of care." For instance, the report notes that readmissions began falling in 2010 when the Hospital Readmissions Reduction Program went into effect.
While CMS has not commented on the GAO report, officials have previously stressed financial incentives will have a long-term effect by encouraging institutions to focus on quality, according to KHN (Kaiser Health News, 10/2).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.