Medicare Value Based Purchasing Program
As healthcare costs continue rising the Federal Government has decided to change the way Medicare reimburses hospitals from a system of activity to pay for performance in a system called Value-Based Purchasing. This means that hospitals that do well versus specific benchmarks will be rewarded and hospitals that perform poorly will be penalized.
There are two areas that Medicare and CMS will benchmark:
- How closely hospitals follow best practices and meet or exceed specific clinical benchmarks
- How well hospitals enhance the patient’s experience of care
The first rating is data from clinical results compared to other hospitals in the program. The second rating is based on a random survey of patients about how they view their recent experience in the hospital referred to as the Patient Experience of Care. Hospitals need to do well in each area, but think about this. Every hospital will focus on the clinical aspects of the benchmarks because that's their primary business. But those hospitals that work to distinguish themselves in the Patient Experience of Care will set themselves apart from their competitors based on the way they educate and "treat" their patients. Think customer service not treatment of care.
The Patient Experience of Care survey will include feedback from patients on these areas:
- How well nurses communicate with patients
- How well doctors communicate with patients
- How responsive hospital staff is to patients’ needs
- How well caregivers managed patients’ pain
- How well caregivers explaine patients’ medications to them
- How clean and quiet the hospital was
- How well caregivers explained the steps patients and families need to take to care for themselves outside of the hospital (i.e., discharge instructions)
- The survey also asks patients to give an overall satisfaction rating to their hospital stay.
Did you know...
- Hospital payments account for the largest share of Medicare spending, and Medicare is the largest single payer for hospital services.
- In 2009 more than 7 million Medicare beneficiaries experienced more than 12.4 million inpatient hospitalizations.
- One in 7 Medicare Patients experience some “adverse” event such as a preventable illness or injury while in the hospital.
- Medicare spent an estimated $4.4 billion in 2009 to care for patients who had been harmed in the hospital, and readmissions cost Medicare another $26 billion.
- One in 3 Medicare Beneficiaries who leave the hospital today will be back in the hospital within a month.
- Changing how Medicare pays for hospital inpatient acute care services is expected to foster higher quality care for all hospital patients.
- In FY 2013, the Hospital Value-Based Purchasing Program will distribute an estimated $850 million to hospitals based on their overall performance on a set of quality measures that have been linked to improved clinical processes of care and patient satisfaction.
- This redirection will encourage care quality improvement, which is intended to result in significant, additional savings to Medicare, taxpayers, and enrollees over time. (Source: healthcare.gov)