Hospital Value-Based Purchasing Update Jim Poyer Director, OCSQ/QIG/DQIPAC April 27, 2011

1. Hospital Value-Based Purchasing Update Jim Poyer Director, OCSQ/QIG/DQIPAC April 27, 2011

2. Value-Based Purchasing and Linking Payment to Quality • Value-Based Purchasing is one important step in revamping how we pay for health care • Will reward better value, outcomes, and innovations instead of volume • Measures should be based on a mix of the following: • Standards • Process measures • Outcomes • Patient experience measures • Care Transitions and Changes in Patient Functional Status • Goal: quickly move to using primarily outcome and patient experience measures (using risk adjustment as appropriate)

3. Introduction: Hospital Value-Based Purchasing (VBP) Program • Required by Congress under ACA section 3001 (adding new Social Security Act Section 1886(o)) • Next step in promoting higher quality care for Medicare beneficiaries • CMS views value-based purchasing as an important driver in revamping how care and services are paid for, moving increasingly toward rewarding better value, outcomes, and innovations instead of volume

4. Hospital Value-Based Purchasing (VBP) Proposed Measure Topics FY 2013: • Process of Care Measures • Acute Myocardial Infarction (AMI) • Heart Failure (HF) • Pneumonia (PN) • Surgical Care Improvement Project (SCIP) • Healthcare Associated Infections (HAIs), as defined by the Secretary’s HAI Action Plan • Patient Experience of Care: • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey FY 2014: • Process of Care Measures: Use all 2013 Measures, plus add 1 SCIP Clinical Process Measure • Patient Experience of Care: • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey NEW TOPICS • Outcome Measures: • 30-day mortality measures: AMI, HF, and PN • AHRQ Patient Safety Indicators and Inpatient Quality Indicators • Hospital Acquired Conditions • Efficiency Measure: • Medicare Spending per Beneficiary

5. How Will Hospitals Be Evaluated under the 2013 Hospital VBP Program? • Proposed Summary for FY 2013 Program: • Two domains: • Clinical Process of Care (12 measures) • Patient Experience of Care (8 HCAHPS dimensions) • Hospitals receive the higher of two scores (Achievement and Improvement) for each measure or dimension as applicable • Individual measure scores summed to create Clinical Process of Care domain score • 8 HCAHPS dimension scores summed with consistency points to create Patient Experience of Care domain score • Total Performance Score based on: • 70% weight for Clinical Process of Care domain • 30% weight for Patient Experience of Care domain