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AHA Letter Details VBP Program 'Failures'

Cheryl Clark, for HealthLeaders Media, August 31, 2011

The Centers for Medicare & Medicaid Services is bypassing rules for how value-based purchasing should roll out and thus is ignoring key requirements set forth in the health reform law, the American Hospital Association said in a strongly-worded 14-page letter released late Tuesday.

Because of these problems, the AHA says CMS must delay introduction of various parts of the VBP program by several months from their scheduled dates.

The Patient Protection and Affordable Care Act of 2010 (ACA) established a Medicare inpatient hospital VBP program to reward hospitals for better performance on quality measures beginning in fiscal 2013, the letter begins. That included "detailed requirements regarding implementation of the VBP program, including the timing of measure introduction and selection.

"Despite the law's specificity, CMS has not met its requirement with respect to certain measures," a failure that "will unfairly and adversely impact the hospital field and even undermine the intent of the law, which is to provide opportunities for hospitals to improve their performance." The Aug. 29 letter to CMS administrator Donald M. Berwick, MD, was signed by AHA executive vice president Rick Pollack. 

Pollack added that the problems spill over to outpatient prospective payment systems because they build on policies "that fail to comply with the law's requirements."

These were among the numerous concerns Pollack listed:

1. A measure can not be used for a performance period unless that measure has been specified by the inpatient quality reporting program – so hospitals can review its performance, request changes and attest to their accuracy. A measure also can not be used unless it has been displayed on the HospitalCompare website for at least one year prior to the start of the performance period.

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