Value Based Purchasing

Also called “Pay for Performance”.  It is a Center for Medicare and Medicaid Services (CMS) initiative that will affect what hospitals collect starting January 2013.  Data collection starts October 2012.  It is a way to partially recoup some of the reductions we will see in revenues.  In general CMS payments (just Medicare) account for around 43% of hospital revenue. By 2017 5-10% of total Medicare payments are at risk.  This is a zero sum game.  There will be loser’s and winners but the pie will not get bigger, just shared differently.

For core measures, CEO/CNO’s need to insist on 100% compliance.  Why?

1)Evidence based, so good for the patient.

2)Publicly available, so good (or bad) for marketing and PR.

3)Effect reimbursement, so leads to dollars (or loss of them)

Ultimately, they are associated with survivability in health care reform.

There are currently over 170 Core measures identified by CMS to be measured and submitted for comparison and the total number of these measures will only increase in the future.  The big ones that are included in value based purchasing for 2013 are listed below.  The bolded ones are impacted by Incendant’s 360 degree patient education product.

Indicators for Process Measures Score Calculation:

  • Heart attack patients given fibrinolytic medication within 30 minutes of arrival.
  • Heart attack patients given PCI within 90 minutes of arrival.
  • Heart failure patients given discharge instructions.
  • Pneumonia patients whose initial emergency room blood cultures were performed prior to the administration of the first hospital dose of antibiotics.
  • Pneumonia patients given the most appropriate initial antibiotics
  • Surgery patients given preventative antibiotics within 1 hour before surgery
  • Surgery patients given the appropriate preventative antibiotic for surgery
  • Surgery patients whose preventative antibiotics were stopped within 24 hours after surgery.
  • Heart surgery patients whose doctors ordered treatments to prevent blood clots for certain types of surgeries.
  • Surgery patients whose doctors ordered treatments to prevent blood clots for certain types of surgeries.
  • Surgery patients given treatment to prevent blood clots which 24 hours before or after selected surgeries.