Page 28 - Hoag Orthopedic Institute 2015 Outcomes Report

“BUNDLED PAYMENTS HAVE YET TO REACH FULL POTENTIAL. BUT THERE ARE AMBULATORY SURGERY CENTERS THAT DEMONSTRATE COST-EFFECTIVE, SUCCESSFUL PROGRAMS. THE ORTHOPEDIC SURGERY CENTER OF ORANGE COUNTY, IN NEWPORT BEACH, CA, HAS EFFECTIVELY RUN A BUNDLED PAYMENTS PROGRAM SINCE 2008.”
BECKER’S ASC REVIEW – OCTOBER 2014
VALUE CONTINUED
VALUE BASED PURCHASING (VBP) PROGRAM
As outlined in the Affordable Care Act, the purchasing program is based on the concept that buyers should hold providers of health
care accountable for cost, quality of care and
the patient care experience. VBP is intended to reduce below-standard care through financial penalties, as well as identify and reward the best- performing providers. Hospitals receive incentive payments based on how well they perform and how much their outcomes improve relative to national performance.
The VBP program began with 20 measures for
FY 2013, increased to 24 measures for FY 2014 and will expand to 26 measures in FY 2015.
VBP requires CMS to withhold 1.25 percent of Medicare revenues in FY 2014, rising to 2 percent by FY 2017. Revenues will then be redistributed
based on quality performance compared to the national mean. Providers’ overall scores will be determined based on quality measures in four VBP domains:
• Clinical Care Domain, which has two sub-domains – Process and Outcome
• Patient Experience of Care • Efficiency
• Safety
Hospitals will receive payments based on their quality performance for previous years. In fiscal year 2015, CMS could potentially withhold 1.5%, if hospitals fail to meet quality standards. HOI met or exceeded CMS quality standards on measured metrics and will receive an additional 1.16% incentive for providing quality care.
Value Based Purchasing Incentive and Withholding Percentage
1.5% 1
0.5
0
- 0.5
-1
- 1.5
-2
1.16%
Source: Quality Net (CMS) Hospital VBP Percentage Summary Report, Report run date July 28, 2014
Quality based performance CMS quality metrics – incentives received by HOI no penalties
28 | HOAG ORTHOPEDIC INSTITUTE
HOI