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Winners (and Losers) in the Quality Race for Cash

Cheryl Clark, for HealthLeaders Media, October 28, 2010

Prior to the meeting, CMS prepared 10 questions to group concerns. Here's how some of the speakers replied:

1. What is an acceptable performance period to determine performance scoring and payment calculations?

"We would ask that any hospitals that do not have data in the baseline period, because they were not already participating in hospital inpatient quality reporting programs, that those hospitals simply be omitted from the (Value Based Purchasing Program) in the first year. No money would be withheld since they wouldn't be able to earn any money back since they didn't have baseline scores. We would hope no hospital would be doubly penalized." Beth Cameron Feldpush, American Hospital Association.

"(We hope that hospitals) will know all of their standards on which their performance will be assessed before the performance period begins. They will know the performance score they must achieve to earn back their full VBP set aside and they will know their VBP incentive will be calculated from their performance score." Christine Van Dusen of Premier Health Alliance.

2. What type of performance scoring methodology should CMS implement to have an immediate and significant impact on hospital performance that improves quality of care received by patients? How should the performance score determine the payment incentive?

"If CMS is serious about true process improvement in inpatient hospital unit, the proposal formulas for scoring against median and top percentiles for the country, this is essentially marking on the curve. It guarantees that even if everyone improves significantly there will be winners and losers. If absolute targets were the key and not percentile-based, true improvement would be rewarded. Otherwise the cynical response will inevitably be that this is a takeaway program masquerading as a quality initiative." Anthony Haftel, MD Franciscan Health System in Seattle.

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