Valuing improvement in value-based purchasing

Circulation. Cardiovascular Quality and Outcomes
William B Borden, Jan Blustein

Abstract

Medicare will soon implement hospital value-based purchasing (VBP) using a scoring system that rewards both achievement (absolute performance) and improvement (performance increase over time). However, improvement is defined so as to give less credit to initial low performers than initial high performers. Because initial low performers are disproportionately hospitals in socioeconomically disadvantaged areas, these institutions stand to lose under Medicare's VBP proposal. We developed an alternative improvement scale and applied it to hospital performance throughout the United States. By using 2005 to 2008 Medicare process measures for acute myocardial infarction (AMI) and heart failure (HF), we calculated hospital scores using Medicare's proposal and our alternative. Hospital performance scores were compared across 5 locational dimensions of socioeconomic disadvantage: poverty, unemployment, physician shortage, and high school and college graduation rates. Medicare's proposed scoring system yielded higher overall scores for the most locationally advantaged hospitals for 4 of 5 dimensions in AMI and 2 of 5 dimensions for HF. By using our alternative, differences in overall scores between hospitals in the most and least advantag...Continue Reading

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Citations

Sep 26, 2013·Nursing Management·Jennifer Rainer
Jun 1, 2013·Healthcare : the Journal of Delivery Science and Innovation·Andrew M Ryan, Cheryl L Damberg
Apr 5, 2016·Journal of Surgical Oncology·Daniel E Abbott
Jun 2, 2016·Circulation·Tingyin T CheeWilliam B Borden
Mar 23, 2012·Circulation. Cardiovascular Quality and Outcomes·Karen E Joynt, Meredith B Rosenthal

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