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AHA Letter Details VBP Program 'Failures'

Cheryl Clark, for HealthLeaders Media, August 31, 2011

"The law requires that hospitals whose payments will be affected by these measures, clinicians whose performance will be judged by these measures and patients whose care will be affected by these measures have the opportunity to know precisely what CMS is measuring, their current level of performance and have an opportunity to improve on measures prior to their inclusion in the VBP program," Pollack wrote.

However, in the fiscal year 2012 inpatient prospective payment system final rule, CMS said "it will generally add measures to the VBP program at the same time it adds them to the IQR program. This is inconsistent with the law. Until a measure is included in the IQR program, CMS will not have measure data to post on HospitalCompare...(and thus) will not have data available to satisfy the statutory requirement" of one year prior to the performance period.

2. The ACA specifies that CMS include efficiency ratings, specifically Medicare spending per beneficiary, in the VBP program for FY 2014 or a subsequent fiscal year. "This is a completely new type of quality measure for hospitals in which they will be held accountable for patient care provided by external and likely unaffiliated providers through 30 days post-discharge," Pollack wrote.

However, CMS has "never released a publicly available specification document for the measure," a critical part because it is "CMS's first foray into efficiency measurement."

For example, hospitals do not know what defines the denominator, the numerator of cases to be included, which exclusions are to be removed from the denominator and how the data will be risk-adjusted.

Hospitals have never been given the opportunity to review their performance on spending per beneficiary, to request changes or attest to the accuracy of the calculation.

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