The AHA and many others say major parts of the regulations lack validity, and may even pose unnecessary risk to patients, in the following ways:
1. Many of the clinical processes of care measures in the formula have already been "topped out" meaning hospitals are now scoring 98%, 99% or 100%, such as, in prescribing aspirin to a heart attack patient at discharge. A hospital scoring 98% would receive one point for achievement for scoring at the threshold, while a hospital at 99% would receive 10 points for this at the benchmark, with no reward for a hospital scoring in between.
"A hospital that consistently performs at a high level of performance, (>=95%) should not be penalized under the current methodology when the achievement thresholds are tightly clustered between 95% and 98%," wrote Bobbie James, outcomes analyst for Intermountain Healthcare in Salt Lake City.
Said Pollack: "Asking hospitals to strive for 100 percent compliance on the measures promotes overuse; that is, the provision of treatment to some patients who may not benefit from it. This is a waste of resources and poses some degree of unnecessary risk to the welfare of the patient."
2. In 2014, the VBP formula will add to the formula eight measures of hospital-acquired conditions (HAC), such as letting patients develop pressure ulcers or forgetting to remove a surgical sponge. But these are the same ones that are included in the current inpatient prospective payment system HAC policy and identical to measures in another section of the ACA that separately penalizes hospitals with high rates these mistakes. "The AHA strongly opposes the inclusion of HAC measures in both the VBP program and the HAC policy because of the opportunity for hospitals to be penalized twice on the same measures,” wrote Pollack.