MOVING HOSPITALS to a value-based payment system won’t be a slam-dunk, according to testimony presented last month in a Senate Finance Committee meeting.
According to a report released by the Government Accountability Office, there are various issues and challenges related to how hospitals submit data and how the Centers for Medicare & Medicaid Services ensures that the data it receives is reliable.
The reliability of data is of key importance as federal payers aim to move to a system based in part on the quality of care provided by facilities. The Deficit Reduction Act of 2005 directs CMS to implement a value-based purchasing program for Medicare beginning in fiscal year 2009 that would adjust payment to hospitals based on quality factors. Last November, CMS issued a report with its blueprint for moving to a value-based system.
While CMS has instituted initiatives to check data quality provided by hospitals, the GAO’s analysis indicates the method used by CMS is “statistically uncertain” for some hospitals because of the small number of records examined – typically five cases per quarter per hospital – regardless of the hospital’s size.
Even as CMS now requires hospitals to attest each quarter to the completeness and accuracy of their data, it acknowledges that it needs to redesign the data infrastructure and validation process to support a value-based purchasing program – for example, by increasing the number of medical records sampled from hospitals, the GAO report said.
In testimony by Linda T. Kohn, acting director of health care for the GAO, the monitoring agency found that current methods for collecting and submitting quality data involve “complex abstraction” to review and assess information in a patient’s medical record.