FEATURE
WHO PUT THE VALUE IN VALUE-BASED PAYMENTS ?
Tom James , MD
For many physicians , the term “ Value-Based Purchasing ” ( VBP ) is code for less compensation and greater work . So they perceive the value equation is seen not in clinical terms but as payment for work-effort . The doctor ’ s view of value-based purchasing is value to someone else = MD effort / MD compensation .
National Quality Strategy goals and types of value-based benefits are on page 11 .
But the National Business Coalition on Health ( NBCH ) states on its website that “ Value-Based Purchasing is a demand side strategy to measure , report and reward excellence in health care delivery .” The business community believes that VBP can be “ a motivator to providers that leads to re-engineering of the health care delivery for quality improvement .”
The real driver in the Value-Based environment is the federal government and not the business or medical community . The Centers for Medicare and Medicaid Services ( CMS ) has used the repeal of the Sustainable Growth Rate ( SGR ) legislation to use its economic muscle to drive a reimbursement strategy aligned with the concepts that Dr . Don Berwick brought to CMS , i . e ., the Triple Aim . The concepts of the Triple Aim as originally developed at the Institute for Healthcare Improvement included Better Care for Individuals , Better Health for Populations , and Lower Costs . With the demise of the SGR , the leadership within CMS felt that development of VBP programs would strengthen the three legs of the Triple Aim .
Starting in 2013 , CMS augmented the National Quality Strategy based upon these new directions in payment . The enhanced goals of the National Quality Strategy ( see Table 1 on page 11 ) were incorporated into its initial four Value-Based Programs aimed first at hospitals , and then physicians .
»» Hospital Value-Based Purchasing ( HVBP ) Program
»» Hospital Readmission Reduction ( HRR ) Program
»»
Value Modifier ( VM ) Program ( also called the Physician Value-Based Modifier or PVBM )
»»
Hospital Acquired Conditions ( HAC ) Program
Subsequently CMS has added more VBP programs for dialysis / end-stage renal disease ; skilled nursing facilities and home health . A study of the impact of the HVBP program was published in the New England Journal of Medicine earlier this year . This review of Medicare data from 4,799 hospitals demonstrated statistically significant improvement in death for patients admitted with pneumonia but failed to demonstrate significance in outcomes for patients with acute myocardial infarction or heart failure . Similarly , there was no statistical improvement in patient experience of care scores . The program is budget neutral with CMS reporting that in 2014 , 56 percent of hospitals received a DRG payment boost while 44 percent had a reduction in base DRG payments . Value-Based Purchasing proponents have argued that physicians will be more capable of demonstrating improvements than hospitals because they are better able to make practice pattern adjustments than hospitals .
In the post-SGR era , CMS has moved its Physician Value-Based Modifier Program into the suite of programs under the Medicare Access and CHIP Reauthorization Act of 2015 ( MACRA ). Much has been written about these programs under MACRA that include the Merit Incentive Program ( MIPs ) and Alternative Payment Methods ( APMs ) in which physician payments will be impacted .
( continued on page 10 ) SEPTEMBER 2017 9