Hospitals that don't perform well under a new value-based purchasing model could lose millions of dollars in Medicare reimbursements beginning Oct. 1, 2012, according to VHA.
The Irving, Texas-based national healthcare network has analyzed performance scores for hospitals across the country and found the national median VBP score is 53. This is with patient satisfaction scores, known as HCAHPS, acting as a drag on the overall score.
To maximize Medicare reimbursement opportunities, VHA estimates that hospitals must score above 70, which is currently the top decile.
Payment will be linked to organizations' quality outcomes and patient satisfaction scores.
The company has also calculated VBP performance scores for hospitals based on the methodology presented by the Centers for Medicare & Medicaid Services to Congress in November 2007 as part of its report on value-based purchasing.
"Many hospital executives are shocked to see their overall performance score, and they are concerned when we begin to explain the potential impact on their organization in a value-based purchasing environment," said Trent Haywood, VHA's chief medical officer and the former deputy chief medical officer at CMS. "Hospitals are doing well across the board relative to their clinical core measures, but their HCAHPS scores will place them at risk."
To help members improve their clinical and patient satisfaction scores and prevent future reimbursement losses, VHA launched its Value Insurance Program Services in May 2010. VIP Services is designed to help organizations focus on specific VBP performance improvement needs.
Hospitals will receive CMS reimbursement incentives for either achieving the baseline performance score or achieving a specific level of improvement relative to their baseline score, according to Haywood.
"This means that taking action now is important even for hospitals that are performing poorly and for whom top decile performance seems unattainable," he said.